ADHD: Now You See It; Now You Don't

Headline in the December 2010 Edition of Clinical Psychiatry News:

"ADHD Diagnosis 'Extremely Transient' Over 1-Year Period." 

The article describes what J. Blake Turner, Ph.D. found when he analyzed serial assessments of 8,714 children and adolescents.  At the annual meeting of the American Academy of Child & Adolesent Psychiatry, he reported that, "Generally, the loss of the diagnosis" was more likely than its persistence over a relatively short period of time. 

Roughly 1,200 total cases were identified initially - a fairly astonishing percentage of the sample in and by itself.  In the four studies looked at, loss of the ADHD disgnosis occured  in 55-75% for the "inattentive" type of ADHD, 55-65% for the "hyperactive" type, and 18-35% for the "combined" type during the year the subjects were studied. 

The disappearance of the diagnostic criteria did not usually result from a small change in those kids who barely met the criteria in the first place - the kids described in the study lost on average five different ADHD symptoms.

Do neurodevelopmental disorders disappear like this?  I think not.  Are the majority of children diagnosed with ADHD merely reacting to stressful environments?  I am sure the reader can guess my opinion on that question.

But did we not just hear a story in the news a couple of months ago about a study that was reported to be proof positive that ADHD was a genetic disease, and therefore could not possibly ever be a behavioral problem resulting from dysfunctional family interactions? 

The study that was widely reported under a headline implying this genetic "proof" of ADHD and disproof of family problems was published in a medical journal called the Lancet on September 30.

In the study's genome-wide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls not diagnosed with the condition were studied. Researchers found that compared with the control group without the ADHD label, children with the disorder were twice as likely — approximately 15% vs 7% — to have copy number variants (CNVs).

CNVs  are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).

Of course, even if the presence of CNV's were serious proof that ADHD is invariably a genetic disorder - and it is not  for reasons I will mention shortly - this would mean that a whopping eighty five percent of kids diagnosed with ADHD did not have the disorder!  That is one hell of a rate of misdiagnosis.

The presence of CNV's do not prove genetic origins for most cases of ADHD at all, although they may quite possibly predispose some individuals to develop deficits in the neural networks of their brains.  As you can see from the above data, 7% of normal kids have them. 

Second, a high percentage of the kids diagnosed with ADHD who did have increased rates of CNVs also exhibited learning disabilities.  In ancient times when I was in training, problems with attention were thought to be a side effect of learning disabilites such as dyslexia.

 Last, the presence of higher numbers of CNV's in the regions of chromosomes the study authors found them in is not specific to ADHD, but is also seen in autism and schizophrenia.

This study should win the Oscar for Most Highly Exaggerated Claims of Significance of Data in a Research Study.  Shame on the press for going along with the ruse.