Psychiatrists Sami Timimi(U.K.) and Peter Breggin(U.S.) members of the Critical Psychiatry Network oppose pathologizing the symptoms of ADHD and other supposed 'mental illnesses' in children. Sami Timimi, who is an NHS child and adolescent psychiatrist, and a Professor at Lincoln University explains ADHD as a social construct rather than an objective 'disorder'. Timimi argues that western society creates stress on families which in turn suggests environmental causes for children expressing the symptoms of ADHD. They also believe that parents who feel they have failed in their parenting responsibilities can use the ADHD label to absolve guilt and self-blame. A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnose with a mental disorder, symptoms must be interpreted as causing a person distress / espec. maladaptive. In America, the Diagnostic and Statistical Manual (DSM-IV) requires that "some impairment from the symptoms is present in two or more settings" and that "there must be clear evidence of significant impairment in social, school, or work functioning" for a diagnosis of ADHD to be made.
In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as 'problems'. Medically defining their behaviour (by giving labels such as ADHD and ADD) serves the purpose of removing blame from those 'causing the problem'. Controversy over the social constructionist view comes from a number of studies that cite significant psychological and social differences between those diagnosed with the disorder, and those who are not. However, the specific reasons for these differences are not certain, and this does not suggest anything other than a difference in behavior. Studies have also shown neurological differences, but whether this signifies an effect rather than a cause is unknown. Such differences could also be attributed the drugs commonly prescribed to people with this disorder. Studies have also been able to differentiate ADHD from other psychiatric disorders in its symptoms, associated features, life course, and comorbidity.
Gerald Coles, an educational psychologist and formerly an associate professor of clinical psychiatry at Robert Wood Johnson Medical School and the University of Rochester who has written extensively on literacy and learning disabilities, asserts that there are partisan agendas behind the educational policy-makers and that the scientific research that they use to support their arguments regarding the teaching of literacy are flawed. These include the idea that there are neurological explanations for learning disabilities. Gerald Coles argues that school failure must be viewed and treated in the context of both the learning environment and the child's individual abilities, behavior, family life, and social relationships. He then presents a new model of learning problems, in which family and school environments are the major determinants of academic success. In this "interactive" paradigm, the attitudes and methods of education are more important than inherent strengths or deficits of the individual child.
Questioning the pathophysiological and genetic basis of ADHD
Some social constructionist theories of ADHD reject the dominant medical opinion that ADHD has a distinct pathophysiology and genetic components. The "symptoms" of ADHD also happen to be morally questionable attributes, this is why the symptoms as described as "inappropriate". Many social constructionists trenchantly question deterministic views of behaviour, such as those views sometimes put forth within behavioural/abnormal psychology and the biological sciences.
Currently, the pathophysiology of ADHD is unclear; although research has found evidence of differences in the brain between ADHD and non-ADHD patients. Critics, such as Jonathan Leo and David Cohen who reject the characterization of ADHD as a disorder, contend that the controls for stimulant medication usage were inadequate in some lobar volumetric studies which makes it impossible to determine whether ADHD itself or psychotropic medication used to treat ADHD is responsible for decreased thickness observed in certain brain regions. They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.
From a biological/genetic point of view, ADHD is said to be highly heritable and twin studies suggest genetics are a factor in about 75% of ADHD cases,. However, the genetic connection is questionable. Dr. Joseph Glenmullen states, "no claim of a gene for a psychiatric condition has stood the test of time, in spite of popular misinformation. Although many theories exist, there is no definitive biological, neurological, or genetic etiology for 'mental illness'." His critics argue that ADHD is a heterogeneous disorder caused by a complex interaction of genetic and environmental factors and thus cannot be modeled accurately using the single gene theory. Authors of a review of ADHD etiology have noted: "Although several genome-wide searches have identified chromosomal regions that are predicted to contain genes that contribute to ADHD susceptibility, to date no single gene with a major contribution to ADHD has been identified."
Alternatives to medicationSocial critics question if environmental changes should be the main line of treatment for those with a diagnosis of ADHD, instead of the medical model which predominantly uses medication and to a lesser extent, behavior modification. Critics believe schools and the health system force children to conform to a narrow, predefined standard of child development. These critics believe that these institutions are propagating the dangerous viewpoint that children with ADHD are maladaptive and disabled simply because they do not conform to a socially constructed norm.[who?] Some people including retired neurologist and CCHR medical expert Fred Baughman have suggested that this viewpoint is ultimately being pushed by the pharmaceutical industry in order to sell Anti-ADHD drugs. Moreover, the argument against ADHD asserts that changing the child through medication regimes may cheat them of certain unique and positive personal characteristics that in turn may limit our collective future.
Sudbury model of democratic education schools' alternativeSome critics of the concept of learning disabilities and of special education take the position that every child has a different learning style and pace and that each child is unique, not only capable of learning but also capable of succeeding. These critics assert that applying the medical model of problem-solving to individual children who are pupils in the school system, and labeling these children as disabled, systematically prevents the improvement of the current educational system.
Describing current instructional methods as homogenization and lockstep standardization, alternative approaches are proposed, such as the Sudbury model of democratic education schools, an alternative approach in which children, by enjoying personal freedom thus encouraged to exercise personal responsibility for their actions, learn at their own pace rather than following a chronologically-based curriculum. Proponents of unschooling have also claimed that children raised in this method do not suffer from learning disabilities.
+ Synopsis of presentation on 10th January 2013 at the DECP Annual Conference, Bristol.
The limitations of Psychiatric diagnosis Professor Sami Timimi, Consultant Child and Adolescent psychiatrist and Director of Pos
Diagnostic thinking has a powerful and pervasive impact on mental health services, structuring guidelines (such as NICE), research, administrative systems and care pathways. This talk will examine what is included and not included in the diagnosis driven ‘evidence base’, which has become prescriptive for practice, not only in mental health, but also more widely across social care and education. Focusing on childhood psychiatric diagnoses such as ADHD, the evidence base that supports (or otherwise) the scientific validity and clinical utility of using a diagnostic framework will be critically evaluated. Ideas on how practice may develop in a direction that is more effective, humane, and more compatible with the scientific evidence will be explored.
Sami Timimi is a Consultant Child and Adolescent Psychiatrist and Director of Postgraduate Education in the National Health Service in Lincolnshire and a Visiting Professor of Child and Adolescent Psychiatry at the University of Lincoln, UK. He writes from a critical psychiatry perspective on topics relating to mental health and has published over a hundred articles and chapters on many subjects including childhood, psychotherapy, behavioural disorders and cross-cultural psychiatry. He has authored four books, co-edited 3 books and co-authored two others. He founded the International Critical Psychiatry Network (http://www.criticalpsychiatry.net) is co-founder of the group ‘Culture and Equality in Mental Health (http://www.cultureequality.org) and is patron to the ‘Carefree Kids’ charity and has led on many innovations including the Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS) project (http://www.oocamhs.com) and the Outcome Orientated Approaches to Mental Health Services (OO-AMHS) project (http://www.innovationforlearning.com/LPFT ).
Timimi S (2002) Pathological Child Psychiatry and the Medicalization of Childhood Hove: Brunner-Routledge Timimi S (2005) Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture Basingstoke: Palgrave Macmillan. Timimi S and Maitra B (eds.) (2006) Critical Voices in Child and Adolescent Mental Health. London: Free Association. Timimi, S. (2007) Mis-Understanding ADHD: The Complete Guide for Parents to Alternatives to Drugs. Bloomington: Authorhouse. Cohen, C. and Timimi, S. (eds.) (2008) Libratory Psychiatry: Philosophy, Politics and Mental Health. Cambridge: Cambridge University Press. Timimi, S. and Leo, J. (eds.) (2009) Rethinking ADHD: From Brain to Culture. Basingstoke: Palgrave MacMillan. Timimi S (2009) A straight Talking Introduction to Children’s Mental Health Problems. Ross-on-Wye: PCCS Books. Timimi S, Gardiner N, McCabe, B. (2010) The Myth of Autism: Medicalising Men’s and Boys’ Social and Emotional Competence . Basingstoke: Palgrave MacMillan. Timimi, S., Tetley, D., Burgoine, W. (2012) Outcome Orientated Child and Adolescent Mental Health Services (OO-CAMHS): A Service Transformation Toolkit. Author House: In press