Tuesday, September 25, 2012

Guest Post: Does ADHD Exist?

The following guest post comes courtesy of Dr. Marilyn Wedge, author of Pills Are Not for Preschoolers, A Drug Free Approach for Troubled Kidswhich I recently reviewed here as part of TLC virtual book tours.

Marilyn Wedge, Ph.D.

In July, 2012, I attended a talk by the distinguished Chilean biologist, philosopher, and constructivist thinker, Humberto Maturana, at a conference at which we were both speaking. Maturana is best known for his theory of autopoiesis. Simply put, autopoiesis (which literally means self-creation) is the view that the world we inhabit is a world that we ourselves create.

Humberto Maturana

According to Maturana, all reality, including the reality that scientific theories claim to illuminate, is ultimately self-referential, and must therefore take into account the scientists who are doing the illuminating.  All theoretical constructs implicitly contain a reference to the person who is doing the theorizing. And, according to Maturana, it is more honest to be aware of the self-reflexivity of our theories than not to be. He is, in a sense, a modern incarnation of the ancient sophist Protagoras, who famously said: “man is the measure of all things.”
Of course, many people have accused Maturana of solipsism [a theory holding that the self can know nothing but its own modifications and that the self is the only existent thing], but I think this criticism misses the point. The importance of what Maturana is trying to convey can be best grasped if we understand his philosophy as a countermeasure to dogmatism. Maturana’s view is humbling--just as he himself comes across as more humble than one would expect considering his fame and importance as a biologist and philosopher. His ideas lead us to question pronouncements of reality that do not take into account the agenda or motives of the people who are doing the pronouncing.
As a therapist, I found Maturana’s radical constructivist point of view very much in keeping with the way I view my work. When a child or young person enters my office, often he bears one or more diagnostic labels. A parent will tell me, “My son’s teacher thinks he has ADHD or ODD” or “my daughter’s pediatrician says she has ADHD.” 

When you think about it, ADHD is a human construction—in particular, a construction by a panel of psychiatrists who authored a diagnostic manual called the DSM-IV. And many of these panelists—56% of them to be exact—accepted money from pharmaceutical companies during the time they were creating the diagnoses in the manual. Here’s an important example of how the reflexive nature of theoretical constructions has to be taken into account to fully understand their nature.
So the answer to the question “Does ADHD exist” really depends on the agenda of the observer. Personally, I find it more helpful to uncover the underlying social causes of a child’s fidgetiness or distractedness and make targeted changes in the child’s social environment to remove the stressors. Does the child hear his parents fighting or arguing all the time? Is the child being abused? Does the child have a teacher who is not able to give him the extra attention he needs because she must deal with an overcrowded classroom? 

I don’t need to construct a diagnosis of ADHD to help a child. In fact, constructing a diagnosis of ADHD is not helpful at all, because the only way to treat it is by stimulant medications, which may, in the long term, be harmful to the child’s brain development or predispose him to become a drug addict as a young adult. Furthermore, constructing the diagnosis tends to obscure the underlying cause of the child’s distress. The diagnosis doesn’t help me to figure out what I need to do to get kids over their problems. Constructing a diagnosis is, however, very helpful to pharmaceutical companies who want to see drugs, and also to DSM panelists who depend on drug companies to fund their research and provide them with elaborate vacations.
From this we can see the power of Maturana’s constructivist theory as an antidote to dogmatic pronouncements of reality—in particular, those of the psycho-pharmaceutical complex.  Using Maturana’s constructivist point of view, ADHD does not exist as an objective reality, and it is up to the individual therapist whether she chooses to construct a child’s problem as ADHD or not.

Marilyn Wedge, Ph.D.  9/6/2012


  1. I actually feel the opposite. I found ADHD to be one of the most helpful diagnoses I ever got. And the reason I think that is because of all the ways to treat it WITHOUT medication. There are many helpful books that have been written on how to treat ADHD without stimulants or any other med. Personally, I was actually looking for ways to cope with being learning disabled (not too much help for that one), when I browsed through the ADHD books and I noticed that a lot of the coping skills used to treat ADHD symptoms also work well for people with LD. And that makes sense to me because I've seen statistics that put the number of ADHD people who are also learning disabled at as high as 60%.

    I recently read some of a book by a psychiatrist with ADHD. His childhood was long ago...before anyone would have thought to diagnose him with it. And he went through all the little tricks he uses (without medication)to cope with his short term memory problems and disorganization.

    I don't know that a lot of people still believe in meds as a must for ADHD. Too many people have it and function without them. There's also been too many books out covering ways to cope with the disorder without meds.

    1. Back in ancient history when I trained - the 70's - ADHD was thought to be a byproduct of learning disabilities and probably nothing more. Now it's become a a new name for "acting out" - and treated with drugs.

    2. I hope you don't treat kids.
      There is the inattentive subtype which does not include symptoms of hyperactivity or externalising behaviour.
      In fact, they often try their darndest to NOT get noticed.
      One of their most common problems?
      Internalising. YES, anxiety, and then depression.
      Try reading this:
      Get educated!

      Good luck...

  2. Thanks for featuring this guest post for the book tour!

  3. Very interesting article and I enjoyed reading about the implications and effects of our taxonomy. I posted a similar article on my website titled hallucination versus reality which deals with the philosophy of perception; I will post a link to this article along with my name.

    Thanks for the very interesting read!

  4. Hello There,
    I just wanted to see if you were currently interested in additional guest bloggers for your blog site.
    I see that you've accepted some guest posters in the past - are there any specific guidelines you need me to follow while making submissions?
    If you're open to submissions, whom would I need to send them to?
    I'm eager to send some contributions to your blog and think that I can cover some interesting topics.
    Thanks for your time,

    1. Hi Tess,

      Yes, I am still interested. You can e-mail me (click my name under "about me" on the right hand side of the blog for the address), and I'll send you my guidelines.

  5. I find your points logical and analytical, however I believe there is more to the picture than what you have briefly mentioned here.

    I would like to add some anecdotal evidence based on my experience as a teacher of school age children.

    I have taught many children with behavioural problems and agree that much of the behaviour stems from the situation at home. However, there are some cases where the home life does not seem to be the deciding factor. (You may point out that a teacher can never fully know what goes on in a child's home, but the interactions between teachers, students and parents give many, many clues).

    I have also observed that sugar and artificial preservatives can effect some children dramatically (while others appear totally unaffected).

    Based on these observations, I believe that many of the behaviours called "ADHD" are caused by environmental factors (family life and diet). Yet there remains a core group of children who present the same symptoms year after year, no matter what teacher they work with, no matter what strategies to teach adaptive behaviour the school offers, and no matter how hard the parents try to find therapies.

    Over diagnosis is likely occurring, the shame is that it masks the cases of children with true biologically based mental illness.