Attention Deficit Hyperactivity Disorder (ADHD) is real. As I discussed at length in a post two months ago, while the diagnosis is a clinical one, that is no different than many uncontroversial medical diagnoses. It is based on solid neuroanatomical correlates, clearly established dysfunction and harm, and standard treatments improve outcome.

Still it remains a popular target for contrarians or those who, in my opinion, want to appear edgy and controversial by going against conventional science. Because diagnosing and treating ADHD often involves prescribing medication to children, there is an obvious emotional hook as well.

Mostly, however, denial of ADHD is based largely on naivety about clinical medicine. Often the criticism comes from psychologists who misunderstand the nature of diseases and disorders in medicine. This time the attack comes from John Rosemond (Wikipedia), a psychologist who has actually been arguing against the reality of ADHD by his own account since the 1980s. He apparently has not updated his views in the last thirty years, despite the fact that the science of ADHD has progressed significantly.

Rosemond is definitely at the far end of the spectrum when it comes to denying ADHD. He writes:

Cancer, high cholesterol, influenza, measles, and a broken bone are realities. Using various tests, physicians can prove their existence. No one has proven the reality of ADHD, oppositional defiant disorder, or bipolar disorder of childhood. They are constructs.

Just to be clear: I am not saying ADHD is over-diagnosed; I am saying it does not exist. It is a fiction.

What he is doing is establishing a false dichotomy. On the one hand we have “real” diseases, such as broken bones, cancer, and infections. They all have demonstrable pathology, abnormal anatomy, altered cells, or foreign invaders. Everything else is not real – it is a construct and a fiction.

This is a common tactic of denialism. Establish a false dichotomy based on arbitrary rules that are designed to exclude whatever it is you wish to deny. Creationists, for example, deny evolution by claiming that “real” science involves experiments in the lab and observations of things happening right now, not inferences about what might have happened in the past. If you can exclude all history as part of legitimate science, then evolution is excluded as a matter of definition. Of course, this is not a valid argument because we can form testable hypotheses about what happened in the past and then test them with observations and experiments.

And yes, the comparison to creationism is both apt and completely fair. Rosemond would arbitrarily exclude from “real” medicine all disorders, all clinical “constructs”, and all syndromes. There are a lot of babies he is throwing out with what he thinks is bathwater.

My favorite example is migraine headaches. Millions of people suffer from migraines. They have a characteristic natural history, typical symptoms, risk factors, lifestyle factors, and response to treatments. There is also no demonstrable pathology with most migraines. It is a clinical diagnosis made in exactly the same way as most psychiatric diagnoses, such as ADHD. You need to have a certain number of symptoms from a list of possible symptoms, with other causes being excluded.

There is no laboratory or imaging test for migraine. It exists entirely as a clinical “construct.” There are plausible neuroanatomical correlates, however, just as there is with ADHD. In short ADHD is as real as migraines. Rosemond’s arguments for why he thinks ADHD does not exist all apply to migraines as well.

Rosemond also states in the article:

ADHD and other childhood behavior disorders were inventions of the psychological-psychiatric-pharmaceutical industry.

Perhaps he thinks that migraines are an invention of the neurologist-headache-pharmaceutical industry. This is yet another feature common to denialist strategies – imply a sinister conspiracy to fake the alleged phenomenon based on assumptions of cui bono. If someone benefits from the science, then the science is fake. Treating migraines is a multi-billion dollar industry. The cancer industry, which Rosemond appears to have no problem with, is even bigger. Those who argue that “they” are hiding a cure for cancer use the same argument, that the “cancer industrial complex” benefits from current treatments and so are hiding a cure.

Global warming deniers use the same strategy, with perhaps the least convincing cui bono argument I’ve heard, that climate researchers are faking the whole thing to goose their funding.

Rosemond also relies on a false argument from authority, citing Jerome Kagan for support of his views. But Kagan’s views on ADHD, which I have already thoroughly demolished in my previous article on the topic, are just as flawed as Rosemond’s.

Finally, Rosemond tries to argue that because mainstream psychiatrists refuse to debate him, he must be onto something and they must not be able to defend their views scientifically. This, yet again, is a common denialist strategy, which we have seen from creationists to HIV deniers. Public debate is a very problematic venue for hashing out complex scientific topics. Such a venue favors those with rhetorical polish and a simple emotional opinion to push. It does not favor scientists who have to correct misconceptions with dense scientific research.

Rosemond wants to accuse psychiatrists of drugging children and then watch them try to explain the neuroanatomical correlates of executive function.

Further, scientists do not necessarily have expertise in pseudoscience, denialism, the public understanding of science, or the nuances of critical thinking (they should, but often don’t). Understanding the science is often not enough to stand toe-to-toe with an experienced crank.

I, however, have no problem debating pseudo-scientists. I publicly invite Rosemond to either write a response to my criticism here, or to come on my podcast, the SGU, so I can explain to him why he has been wrong for the last three decades, and give him an opportunity to explain to me why all of neuroscience is essentially flawed.

Finally, I want to point out that Rosemond is not only applying a double standard to ADHD vs other noncontroversial medical diagnoses, but he is also applying a double standard to his own advice. He is primarily an advice columnist. He has written books, such as, John Rosemond’s Fail-Safe Formula for Helping Your Child Succeed in School. His website is full of columns that are based on his personal experience and his philosophy, with a noted paucity of citations from actual published research.

He unfairly criticizes the science of ADHD, while substituting his own home-spun advice which seems to be little more than his personal beliefs.

Rosemond appears to be part of the child-rearing self-help industrial complex, benefiting from poorly sourced advice and bashing mainstream psychology because they are the very experts who can call him out on his BS.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.