Scientifically speaking, the status of attention deficit hyperactivity disorder (ADHD) is shaky. There is no physiological or genetic test for the condition, mental health professionals routinely disagree over whether to diagnose an individual with it, and its symptoms are phenomena that we have all experienced: inattention, overactivity, and impulsiveness. It would seem easy, then, to produce a book exploring these weaknesses of the ADHD construct in detail and pointing out the foundational issues (problems with psychiatric diagnosis more generally, for instance) that make ADHD such a contentious topic.

That is not quite the book that Lloyd, Stead, and Cohen have edited. Instead, the book is a mixture of original empirical research on children's classroom behavior, a theoretical analysis of free will, a synopsis of the eugenics movement, and many other things. The chapters vary widely in quality; some of the contributors appear to be knowledgeable about both their topics and ADHD scholarship more generally, whereas other authors appear to be ignorant of previous work on their topics as well as basic definitions and distinctions in the area of ADHD.

Following an introduction, the book begins with a very useful chapter by David Cohen, who summarizes recent critiques of what he terms the " 'ADHD' enterprise." He helpfully classifies a diverse set of critics into those who view ADHD as a sociocultural construction that fulfills certain societal goals, critics who accuse ADHD advocates and researchers of outright lies and personal intolerance, and critics who focus on the ethical problems with drug treatments for ADHD. Cohen does not evaluate the arguments of these critics, but this is not his aim, and the chapter remains a unique kind of annotated bibliography for readers interested in getting "up to speed" on the critical perspective on ADHD.

The next chapter was contributed by Thomas Armstrong, well known for his 1997 book, The Myth of the A.D.D. Child. Armstrong asserts that our society is too fast-paced, that television commercials have too many sudden "jolts," and that children today are not given enough time to play actively. Somehow these claims are taken as premises supporting a conclusion that ADHD is not a valid diagnosis and that stimulant medications are actually harmful rather than helpful. The causal pathways between these purported failings of contemporary society and ADHD are murky, and Armstrong never makes a clear argument for what they might be. Even his observations are just that—observations, unsupported by anything more than anecdotal evidence. Armstrong supports his claim about children's play time by telling us that his wife knows kindergartners who have two hours of homework each night. Most of his other claims do not specify any information source. He is long on suggestion and short on careful reasoning, offering that Albert Einstein was "seen to possess childlike…qualities that were integral to [his] great discoveries," and leaving us to trust him that this tendentious biographical remark means that ADHD "may actually be an evolutionary advantage."

Armstrong's chapter is, thankfully, unique in its tendency towards radical and sensational claims. More common are detailed case studies of how ADHD has been identified or treated within certain specified populations. The book's fourth chapter focuses on Native American children, and its author, a clinical psychologist serving Native American populations in Washington State, claims that behaviors that appear to be ADHD are actually "overt resistance to teaching approaches and learning styles felt as culturally undesirable or foreign." This claim is not unreasonable, but no evidence is provided to support it. No empirical research on the "learning styles" of Native American children is presented, and we are not even given data on the prevalence of the ADHD diagnosis in this population, information that would seem to be critical in establishing evidence for misdiagnosis. Instead, the chapter fills its pages with a review of the history of eugenics and excerpts from early reports on psychiatric disorders in Native Americans. These artifacts certainly show racial prejudice and cultural insensitivity, but they only distract the reader from the author's weak central claim.

The next chapter, contributed by Gordon Tait, is entitled "A Philosophical Examination of ADHD." Philosophical analysis is known for its stress on careful definitions, and this chapter begins with an odd one: we are told that ADHD is "primarily a theory concerning the misbehavior of children." Does Tait mean that one explanation of why some children misbehave is that they have a disorder called ADHD? How could ADHD itself be a theory? Unfortunately, there is no time to dwell on this puzzle; Tait rushes through some basic philosophical terminology, concisely covering various theories of truth as well as major positions in the free will vs. determinism debate. Through it all, ADHD is used as a running example. Some useful distinctions are drawn; for instance, Tait points out that the question of whether or not ADHD "exists" is itself predicated on certain assumptions about the nature of truth, including that there is one right answer to such questions. He also notes the problems involved in attributing ADHD-related behaviors to the presence of a disorder in some children (those with an ADHD diagnosis) but not in other children. These are important clarifications, but Tait ignores the contributions of clinical scientists to this discussion, failing to engage with, for instance, Russell Barkley's careful analysis of nature of self-control or Frank Gresham and James Ysseldyke's work on pragmatism in special education labels. Tait's reference list, containing more introductory philosophy texts and anthologies than works on ADHD, says a great deal about the chapter's style of scholarship.

Among the remaining chapters, one calls out for special notice. In this chapter, Ken Jacobson reports data from what appears to be his dissertation on the ADHD-related misbehavior of children in different educational settings. Jacobson recorded the individual behaviors (e.g., looking, talking, moving one's body) of children in five classrooms and found that misbehavior, at least as he defined it, was quite common. From this, Jacobson concluded that it is not "scientifically possible to separate 'normal' from 'disordered' levels of behavior" and that "it may well be that…no child should be labeled" as having ADHD. Of course, as Jacobson notes, he had tremendous difficulty in interpreting whether individual behaviors should be interpreted as appropriate or inappropriate. This measurement issue was compounded by Jacobson's awkward role as an "observer" who was sometimes charged with classroom management responsibilities; he tells us of times when he had to ask students to calm down and other times when he responded to misbehavior by giving the child a knowing smile. It is difficult, then, to know how the "data" should be interpreted and what, if anything, can be concluded.

Not all of the chapters are as bad as this, and my summary has been a bit unfair, in that I've focused on the book's most egregious errors and lapses in reason. In fact, the book includes a useful summary of Italy's reception of the ADHD construct, an interesting study about how inclusive education practices in South Africa increase the pressure to label and treat children with disruptive behavior, and a concluding chapter arguing for an appreciation of the environmental factors that affect classroom behavior. These chapters contain novel, helpful information even if some of their conclusions, like those of the other chapters, overreach a bit. But overall, the overreaching is substantial and deeply disappointing. Given a topic (ADHD) that seems so ready for thoughtful critique, the contributors to this volume have missed out on an important opportunity. Rather than offering careful argumentation and sober analysis, most opted for speculation, insinuation, and unsupported assertion. The worthy and timely task of critiquing ADHD without hyperbole, then, remains to be done.

© 2007 Benjamin J. Lovett

Benjamin J. Lovett, Ph.D., is an assistant professor of psychology at Elmira College, where he teaches classes on a variety of topics in psychology and his research focuses on the conceptual and psychometric foundations of psychoeducational assessment and psychiatric diagnosis.

Categories: Psychology, Philosophical