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1. 00:02 There is no profession more prone to fads and fashions and mass psychosis and mass hysteras than what else? Psychology. Clinicians of all kinds, psychiatrists, psychologists, licensed social workers, you name it, therapists. Clinicians of all kinds are in the grip of narratives
2. 00:26 that emerge time and again. and I have dealt with the um fad of autism spectrum disorders. I encourage you to go to the description. There are links to two videos I’ve made with a literature review. And I think another fad, another fashion is ADHD, attention deficit hyperactivity
3. 00:52 disorder. And don’t get me started on self-styled experts on Tik Tok, Instagram, and YouTube. These hallowed academic Ivy League platforms. Today we’re going to discuss ADHD. Is it nonsense? Is it real? Is it a fad? And how should we how should we view it? My
4. 01:17 name is Sambakn. I’m the author of malignant self- loveve, narcissism revisited, which started a fad known as narcissistic personality disorder and a professor of psychology. Okay, let’s delve right in. The Centers of Disease Control and Prevention, what’s
5. 01:36 left of it under Kennedy, reported last year that more than 11%, that’s one out of every nine American children, has been diagnosed with ADHD. Only in the 1950s and 1960s, ADHD has been unheard of. There’s always been inattentive children, children with
6. 02:01 fleeting attention, attention deficits. Always been disruptive children. There have been difficult children. But ADHD was unheard of. What has happened? Has there been an unrecognized seismic genetic shift, a tectonic earthquake in the composition of the human mind?
7. 02:22 What has happened? Here’s the truth. The diagnostic criteria of ADHD are, and I’m using a British understatement, not solid, not supported by evidence, studies, and scholarship. I’ll repeat this for your benefit. The diagnostic criteria of ADHD, especially
8. 02:47 in the Diagnostic and Statistical Manual, are made up of pure whole cloth. They are sucked out of the air. They’re invented from someone’s backside. There is no scholarly literature, studies or or anything that support the majority of these diagnostic criteria.
9. 03:09 Additionally, there are no biohysical markers for HD ADHD despite the claim oft repeated and unsubstantiated that ADHD has a hereditary or genetic component. There is no marker. There’s no way to test someone’s blood, someone’s urine, other bodily fluids,
10. 03:30 bodily tissues, the brain, fMRI, something. There’s no marker that is correlated strongly or highly with ADHD. Now, we’ve been using for decades stimulant medications to counter this bargeoning epidemic or shall I say pandemic of ADHD which has swept along
11. 03:57 one ninth of our children. and stimulant medications aderall and others have been associated with observable changes in behavior. Here are the disclaimers and the qual qualifications for this statement. These changes in behavior have not been observed in all situations. In other
12. 04:20 words, they are not unequivocal. They are not monovent. The changes in behavior following the consumption of stimulants are highly dependent on context, circumstances, the situation, the environment and the presence or absence of other people and whatever changes
13. 04:44 have been observed are highly temporary. I’ll discuss it a bit later. So this raises fascinating questions. Is it actually the stimulant, the drug, the medication? Or is it maybe a placebo effect? Maybe some environmental cues and stimuli create the impact, the alleged
14. 05:09 impact of the stimulant. If a medication works, it works in all circumstances, on all people, in all environments, and in all contexts. If a medication works only in highly specific situations, then we should doubt the medication and its potency and
15. 05:30 its alleged impacts and effects. Professor Edmund Sonuga Bark um a neuroscience and psychiatry researcher at King’s College London gave an interview recently to the New York Times. There was an article published in the New York Times. I’ll come to it a bit later, but he gave an
16. 05:52 interview within this article and he said, “We have clinical definition. We have a a clinical definition of ADHD that is increasingly unanchurred from what we are finding in our science. Clinicians cannot objectively measure and define a natural category of individuals with ADHD.”
17. 06:13 And this of course raises the intriguing possibility that most ADHD research is highly dubious, not to say completely invalid. The main study, the mainstay of of the study of ADHD is a longitudinal survey known as the multimodel treatment of attention deficit hyperactivity
18. 06:41 disorder study. MTA for short. It has been funded by the National Institutes of Mental Health and it was a multi-sight study designed to evaluate the leading treatments for ADHD including behavioral therapy medications or a combination of the two. The primary
19. 07:02 results were published in 1999 and follow-up data continue to be published much later. The questions of the study have been modified in both 2007 and 2009 with slight modifications in 2008. The study demonstrated that the effects of medications were
20. 07:21 statistically significant at 14 months later. In other words, medications prescribed for ADHD had lasting impacts 14 months later. However, they had lost their significance after 36 months. So whatever changes the medications have wrought these changes were temporary and even
21. 07:49 with continued consumption of the medication after 36 months they’ve had zero impact. Even more interesting is a recent observation that 40% of the control group in that study who did not qualify for an ADHD level label in 1999 we’re talking were later diagnosed with ADHD
22. 08:10 in adolescence. So something happened to these people. They were not ADHD when the study started and then they graduated into adolescence. They became teenagers. Then suddenly there were ADHD. What has what has happened? Obviously either something intrinsic or something
23. 08:34 exttrinsic. We know that adolescence involves for example hormonal changes and other neurobiological alterations especially to the brain and central nervous system and these are not minor. Could these have brought on the new ADHD diagnosis later on in life?
24. 08:56 Or maybe something extrinsic, something in the environment that has changed over time. The New York Times referred to several studies. The article referred to several studies. By the way, you can find literature. There’s a list of literature in the description.
25. 09:15 And so the the studies have shown that stimulant medication did improve behavior, the ability to work, con to focus, to concentrate on work and the speed of the work, but there was not demonstrable improvement in learning. Margaret Sibli, a clinical psychologist
26. 09:37 and professor at the University of Washington School of Medicine, attempted to explain this amazing transition from non ADHD to sudden onset of ADHD in adolescence in the MTA control group. And she she suggested that what has changed for these children
27. 09:57 was the environment, nothing internal but external. She said that the world of of an adolescent is much different from that of an eight or nine year old often more turbulent. Joel nigg a clinical psychology psychologist at Oregon Health and Science Universities says that for large
28. 10:20 percentages of individuals diagnosed with ADHD there is nothing neurobiologically notable about them. They’re not as you would say neurode divergent. Instead, the symptoms are situational or conditional. What are these situations? What are these conditions that induce mysteriously
29. 10:40 abruptly ADHD in people who have not been diagnosed with ADHD throughout the previous part of the lifespan in childhood for example? What are these conditions that can trigger behaviors that are commonly associated with the ADHD bargeoning fattish label?
30. 11:00 So um one could make a list of such conditions or one could consider situations in which as Sonugo Bark says there is a misalignment between a child’s biological makeup and the environment in which they’re trying to function. That’s an intriguing thought.
31. 11:24 What this what this expert is saying, what he’s suggesting is that ADHD is a is reactive. It’s a reaction when there’s a discrepancy between one’s abilities, innate abilities, neurobiological abilities, biochemical abilities, brain cerebral abilities.
32. 11:45 When there’s a discrepancy between these types of capacities and the demands of the environment, ADHD ensues. It’s a novel way of looking at a ADHD as a kind of maladaptation, not a neurological problem, not a genetic hereditary issue, but a maladaptive reaction to the exigencies
33. 12:12 of a a difficult demanding environment. ADHD symptoms in this point of view are not a single condition but an expression of a mismatch between a person’s capabilities physical, emotional, psychological, intellectual and the environment. There is an assumption
34. 12:34 which is pretty safe that the population is made up of individuals with a wide range of abilities and a wider range of vulnerabilities. Some people when they are exposed to a changing demanding exigent difficult vicitudinal environment some people are
35. 12:53 more vulnerable to change. They are more vulnerable to demand. They they’re less adopted. They’re less capable of coping with the requirements and expectations of others of a workplace or of various institutions such as marriage. And so they they discombobulate. They go haywire.
36. 13:14 They they dysfunction, they misfunction. And this gap between what you are and how you are you’re expected to cope and to behave. This gap uh is called is actually just another name is is another uh raification of ADHD. This is ADHD. Some people are more easily um
37. 13:41 prone to exhibiting ADHD like symptoms at times of stress. Others are more resistant. And at the end of the spectrum, there’s a small group of children who were born with neurochemical problems that make them highly or much more likely to exhibit ADHD symptoms.
38. 14:03 And so I would like to read to you an extended excerpt from an article titled ADHD not a diagnosis but a warning label was written by William G Wiloff MD for the Medscape commentary letters from Maine section. And here’s what he has to say. Individuals with fetal alcohol
39. 14:25 syndrome are probably the best example of a group that may have an identifiable biioarker for ADHD. Although it is likely that research will identify a mechanism to explain the ADHD like symptoms in this very small subset. It is much less likely that a similar
40. 14:43 mechanism or structure will explain the spectrum of vulnerabilities in the general population in the short term. However, if and when a biomarker is discovered in the general population, we must be careful about the chicken and egg situation. Was the environment
41. 14:59 individual mismatch a result of altered structure or chemistry or did the stress associated with the mismatch trigger the observed change? Finally, says Wilkov, let’s consider what may be the most common example of a mismatch between the individual’s biological makeup and their
42. 15:20 environment. Sleep deprivation. When people are made sleep deficient, they exhibit symptoms often linked with ADHD, such as slower reaction times, attention deficits, difficulties, mood changes, and irritability to name just a few. It has been my observation over
43. 15:42 five decades of observing children and adults that very often sleep deprivation is a major if not the most potent contributor to what others have labeled as ADHD. Then it is not surprising that a stimulant medication in an individual who is sleepd deprived will cause a
44. 16:02 dramatic although not longlasting improvement. One of the most common complaints voiced by persons labeled as having ADHD is that they find school or their job boring. Individuals with boring jobs such as a truck driving, truck driving or assembly line work dominated by
45. 16:22 repetitive tasks can be more productive when they’re giving us given a stimulant. If we are looking for a change in the environment that has occurred over the past three quarters of a century to explain the ADHD phenomenon, we need we need look no further than the well
46. 16:40 doumented observation that individuals of all ages are getting significantly less sleep. The reasons are too numerous to document in this short column, but the popularity of television and personal electronic devices are obvious examples. Yes, we must look at our
47. 16:59 educational system to make sure we are creating learning environments in which children who have a variety of skills and v vulnerabilities can thrive. Yes, that school environment should be stimulating without being distracting and provide an abundance of physical
48. 17:15 activity. But we must remember to make sure that families are taught to identify when their child is overt tired and how to take appropriate measures to ensure they arrive at school well-rested. I would add to this changing school hours and starting at
49. 17:35 10:00 in the morning, not at 6:00 or 7:00 in the morning. Continue. I’m continuing the excerpt from the article. View ADHD, says Wilkov, not as a diagnosis, but rather a collection of observations of a patient’s behavior. That should serve as a warning label.
50. 17:53 This doesn’t mean we should completely rule out stimulants as a therapeutic option. However, medication should be considered a temporary step while more definitive steps are being taken to narrow the discrepancy between children’s own resources and the
51. 18:08 environment in which they find themselves. And finally, in the literature, I’m referring you to the New York Times article, Have We Been Thinking about ADHD All Wrong? April 13th, 20125. There’s a link to the multimodel treatment of attention deficit hyperactivity disorder study,
52. 18:28 the MTA study, and a link to William Wilkov uh Wilkov’s column or letter from me. So now sit back and remember in 1973 homosexuality was included in the diagnostic and statistical manual as a mental illness.