The scientific integrity of ADHD: A critical examination of the underpinning theoretical constructs

Abstract

Prior to the establishment and promotion of ADHD as a psychiatric disorder, the labels “minimal brain dysfunction” (MBD), “hyperactivity” (HA), and “learning disability” (LD) were diagnostic terms for children with hard-to-manage behaviors. At the time, these labels and the treatment interventions, especially the heavy reliance on stimulant medications, were subject to criticism. Nearly half a century later, these criticisms apply equally to ADHD, suggesting a disturbing lack of progress in this area of child psychiatry. Therefore, the aim of this article is to examine the scientific integrity of ADHD, to establish why this is the case. I use a philosophy of science framework to track the initial thinking, the plausibility, and the acceptance of ADHD. I establish that ADHD, along with the evolving biomedical model for psychiatry, was accepted in the third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual (DSM-III) as the result of bias and compromise between theorists' of different persuasions. Although initial ideas are expected to be subjective, they also need to demonstrate plausibility prior to empirical investigation. Research from the disciplines of biological psychiatry and cognitive psychology influenced the creation of ADHD, so I critically examine specific ideas that underpinned these disciplines at that time. I find these to be implausible and not congruent with current scientific knowledge, this extends to more recent theory. I conclude there is little good reason to consider DSM-III's concept of ADHD as empirically confirmed, nor do I find good reason to expect such confirmation will be forthcoming.

Socioeconomic disparities in attention deficit hyperactivity disorder (ADHD) in Sweden: An intersectional ecological niches analysis of individual heterogeneity and discriminatory accuracy (IEN-AIHDA)

“…entity that exists independently of human systems of classification [15]. On the other hand, sociologists [16] and critical psychiatrists [17] have emphasised how societal and cultural processes have led to an expanded use of the diagnosis, and the scientific integrity of ADHD has also been questioned [18]. Others [19] have nuanced the tension by emphasizing how considering a diagnosis as a societal and cultural process, does not suggest that the diagnosis is not real in a specific context.…”

Does Using Core Quadrants Lead to More Teacher Self-Efficacy and Less Perceived Problem Behaviour?

“…Mental disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-an internationally used handbook of clinical psychiatry. The present and fifth edition appeared in 2013, and its text revision in 2022 (American Psychiatric Association, 2013/2022. According to Allen Frances, the chair of the fourth edition that was issued in 1994, the DSM-IV in particular contributed to an 'epidemic of childhood disorders' (Frances & Batstra, 2013).…”

“…The unintended consequences of the minor changes made to childhood mental disorder definitions can therefore not as readily be undone. While the DSM was originally intended to facilitate mental disorder communication among professionals in the field, under the influence of the pharmaceutical industry and biological psychiatry, a biomedical framing of the disorder categories soon became dominant (Lafrance & McKenzie-Mohr, 2013;Mills, 2022). The biomedical model of mental disorder places the cause of emotional and behavioural problems with or of a child, in the child and the child's brain (Heagle & Hodge, 2016).…”