The Emperor’s New Diagnosis

In the original story by Hans Christian Andersen, the Emperor was merely deluded that he was fully dressed when he wasn’t. But what really happened was that the Emperor was suffering from a neurodevelopmental disorder that caused him to be so distracted and excitable that he rushed out of his palace to parade around stark naked in front of his people. Clearly, he had what is now known as attention deficit hyperactivity disorder (ADHD).

In trying to learn more about this matter, I came across an article from 2021 with the intriguing title, Adult attention-deficit hyperactivity disorder: From clinical reality toward conceptual clarity. This article assumes that an entity called ADHD exists in nature. Although the sub-title refers to ‘clinical reality,’ the authors immediately contradict themselves by saying at the beginning of the Abstract: ‘There is ambiguity about the clinical picture and concept of ADHD.’ Nothing daunted, they continue: ‘Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning.’ (My emphasis.) But, if there is ambiguity about the clinical picture and concept of ADHD, it’s an unwarranted assumption to speak of a significant prevalence of adults in whom ADHD affects the quality of socio-occupational functioning – they do love big words – even if this is only a suggestion.

All you never wanted to know about being an ADHDer
Are you, or might you be, someone with ADHD? If such a diagnostic label is confirmed, you’ll be known as an ADHDer [sic] according to an organisation calling itself, indeed, the Attention Deficit Disorder Association or ADDA. (What happened to the hyperactivity bit then?) It’s based – where else? – in Los Angeles in the US state of California. But what an unfortunate label to have attached to yourself: you have a ‘deficit’ and a ‘disorder’ of some sort.

What is ADHD anyway? According to ADDA, it’s a neurodevelopmental disorder. And what might that be? It’s an abnormal state of the brain that exists in someone with ADHD. But how do we know someone has ADHD? Because they have a neurodevelopmental disorder. This is the kind of logic to be found in the website of the above-mentioned Association. So, let’s take a deep dive, as the expression has it, into their content and see what else comes up. To start with, we’re presented with an alarming statistic:

Over 12 million – or 1 in 20 – adults in the United States have ADHD, yet 85 per cent have not been formally diagnosed or treated.

How do they know this vast number of adults ‘have’ ADHD if they’ve not been formally diagnosed? They also add: ‘The reality is that ADHD diagnosis is hard.’ Quite.

Just for fun I took their screening test. It consists of six questions of which the following is an example: ‘How often do you leave your seat in meetings or other situations in which you are expected to remain seated?’ You’re invited to pick one of five answers: never, rarely, sometimes, often, or very often.

I did try to answer honestly. No good. My result was 1,226 which was below the threshold of 1,339. So I tried again. This time I scored 1,736 which apparently meant that I ‘have some specific symptoms related to ADHD.’ I was told, however, that ‘this is not an ADHD diagnosis; this is just a screening test.’ Relief. Nonetheless, I was advised to ‘talk to my doctor or another medical professional to get a diagnosis.’

Speed on prescription
It’s interesting that they say, ‘get a diagnosis’. In other words, it’s the patient who decides the diagnosis and seeks confirmation from a medical professional. I wonder how often the medical professional does not concur with the patient and the following conversation takes place:

Patient: Doctor, I think I have ADHD.
Doctor: [After carrying out a full physical and psychological examination] Actually, you don’t have ADHD. You’re just sometimes inattentive due to being easily distracted, and occasionally you’re impulsive, but you don’t have a brain disorder.
Patient: [Sotto voce] Damn. I was hoping to get speed on prescription.

This screening test is the ‘WHO Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5.’ It was compiled by eight authors in 2017 and the paper wherein it is described contains a long list of their conflicts of interest. These are chiefly with various drug companies that make the drugs used to ‘treat’ ADHD. You can draw your own conclusion.

How to deal with awkward questions: ignore them!
Back to ADDA. I have to say that this organisation, under the guise of existing for the purpose of helping poor suffering humanity, looks to me suspiciously like a money-making enterprise. I don’t want to make unjustified aspersions, but although it’s a non-profit outfit in the US, which just means they don’t have to pay tax, how do they get their funds? According to the ADDA website they’re supported by fees from people who join their support group, called ADHD+ which, we’re told, has 5,000+ members. The fees for an individual member are $109.99 yearly or $219.99 yearly for family membership. Furthermore, they admit to receiving occasional donations from pharmaceutical firms, but they refuse to say from which ones or how much.

One of the founders of this organisation, Dr George Sachs, is a ‘licensed child and adult psychologist specializing in ADD/ADHD and Autism Spectrum Disorders.’ He seems to be doing rather well with ADDA and an associated set-up called Inflow. These organisations run courses and webinars, which you are encouraged to join for a fee,

There’s nothing wrong with running inspirational courses to help people organise their daily lives and improve their time-keeping, but why, instead of being aimed at the general public, is the target audience people with ADHD? This merely perpetuates the idea that there is a vast number of people with an incurable brain disorder of this name.

Out of curiosity I viewed one of their free Webinars, presented by Dr Sachs himself. This is part of what he says (paraphrased for readability):

I have ADHD and I was diagnosed self-diagnosed [sic] at graduate school at the age of 35…at graduate school I self-diagnosed with ADHD and then set upon the long journey of finding out what was wrong with me and trying to fix myself…and I discovered I wasn’t somebody who needed to be fixed and frankly what I discovered was that I couldn’t fix myself…with ADHD we still see our flaws and our deficits….I’ll give you an example.

The example is that he forgot his passport on the way to an international flight and had to go back home for it and get another flight.

I say this out of acceptance as a person with neurodivergence, a person with ADHD…the toxic shame of ADHD…causes shame and depression which are symptoms of ADHD…the goal is self-acceptance

The reason I recommend prescribing medication to a child is not so they can get better grades in school. I say to the parent your child may be the erm the erm you know being rejected by the teacher and therefore by his peers…so if the medicine can help the child to calm down so he doesn’t develop this internalised shame which later as an adult can manifest as deep depression or addiction this is the problem so if you have ADHD you know exactly what I mean.

Could this rambling self-contradictory speech perhaps be symptomatic of ADHD? If he has it, he admits (twice) it was self-diagnosed. But he seems to have made a successful career out of treating other people who allegedly have ADHD. As for forgetting his passport, this must be a regular occurrence at airports but is it a symptom of a mental disorder?

Then we come onto his recommendation that children be medicated for presumed ADHD. This is shocking. And what sort of teachers do they have in the US who reject children who may be difficult to handle? For all Dr Sachs’ learning, is he unaware of the harms of prescribing stimulants to children? These include growth retardation, agitation, sleep disturbance, emotional lability, social withdrawal, heart problems, and predisposition to Parkinson’s disease in adulthood.

As for internalised shame, I would think this is more likely to happen to a child who is prescribed medication: he can’t be considered ‘good’ and be accepted by teachers or peers unless he takes a pill every day.

ADHD industry
It’s high time that so-called ADHD is seen for what it is: not as a brain disorder but a social construct and a huge money-spinner for Big Pharma and others in the ADHD industry.

Text © Gabriel Symonds

Picture credit: Wikimedia commons