The complexities of ADHD

There have been controversies about the existence and nature of attention deficit hyperactivity disorder (ADHD) since George Still first described it in 1902. The “new look” presented here is the notion that the diagnosis is used as a quick fix to deal with complex situations, allowing one to write a prescription rather than attempt to understand a complex psychodynamic problem. There can be no objection to this approach as our profession has some expertise in producing epidemics which disappear as rapidly as they have appeared — consider the rise and fall of repetitive strain injury (RSI).

This book argues that there are many pressures in modern society urging us to find a quick fix, ranging from the activities of the pharmaceutical companies, to the DSM-IV-driven push to confine human distress within categorical boundaries. This is true, however one must examine the total situation, and this is where the authors’ bias shows.

Being psychodynamically oriented, they see it as likely that wisdom is to be found in that direction. So it may be, but it is not many years since their antecedents proclaimed that schizophrenia was due to the activities of “schizophrenic” mothers, autism to cold-hearted parents, and the “psychosomatic” disorders to psychodynamic mechanisms. For example, Alexander regarded ulcerative colitis as a regression to the anal stage of psychosexual development, while Szasz and Cushing emphasised the orality of the disease. There were descriptions of the “typical conflict situation” associated with peptic ulcer and asthma. No theoretical position has a mortgage on wisdom.

There are some facts about ADHD which will not go away. They emerge most clearly when one deals with adults who are able to give a good account of themselves. It has a firm correlation with dyslexia and anomalies of motor dominance, such as being left-handed and right-footed. Recent work suggests that chromosome 6p may be involved. There are well-established neuroimaging anomalies and there is the paradox that the hyperactivity calms with stimulants instead of being exacerbated.

By all means let us look carefully, but let us look in all possible directions.

John H T EllardPsychiatrist Balmoral Beach, NSW