The "neurodiversity" viewpoint here is that what we call "ADHD" is part of the natural variation in how human brains work, and that it's a category error to think of it as a malfunction to be repaired, but rather as a difference to be accommodated. That accommodation may or may not be via medication and therapy, but that shouldn't necessarily mean that the underlying neurological state is a diseased one.
A good analogy would be height: a person who is several standard deviations from the mean will face challenges in life that require various forms of intervention, but we don't generally think of them as having a _disorder_ unless there's an identifiable biological cause that usually has other effects.
Another good point of comparison is vision. We can accurately measure vision and create medical devices to correct unwanted variation. As someone with myopia, I find it to be only slightly medicalized -- going to get an eye exam doesn't feel much like visiting a doctor, and people don't tend to talk about it as one does a medical condition. I imagine that if we were able to make a similar kind of standardized assessment of whatever neurological basis there is for ADHD, we would consider medication for it more akin to a stepladder or a pair of glasses (or even an antihistamine) than a treatment for a mental illness.
I'm several standard deviations above the mean in height and it absolutely is a disorder. I can point to the exact hormonal pathway that led to it along with a specific biological root cause, but even if I couldn't, I think it would be disordered. I'll die earlier than a shorter person, have joint and bone problems, have cardiac issues, and nightclubs are way less fun when you can see the entire room.
More to the point, I don't think I'd consider it very offensive if someone called my height a disorder, because it's not core to my identity in the same way thinking is. Calling ADHD (or autism, etc.) a disorder feels like telling someone they're personally deficient, because the person is inextricable from the condition. Growing really tall in your teens is something that happens to you; having ADHD your whole life is something that you are. Note that this is true even if their thinking does meet the criteria to be a disorder.
> and people don't tend to talk about it as one does a medical condition
While I basically entirely agree with your comment, my partner (who is an optometrist here in Australia) would often point out to me that myopia is a big risk factor for retinal degeneration and detachment, open angle glaucoma, and cataracts at a young age. So while we definitely shouldn't treat mild myopia (like I, and likely you have) as some horrific medical condition, she also gets a bit frustrated by general practitioners and retail optoms who don't treat a lot of the eye diseases she handles with the gravity some of them actually should bear.
Anyway this is a massive tangent, just was something interesting I wanted to share!
Fascinating. Seems to me that it would be a comorbidity with a common cause though, rather than the myopia being the causative factor?
My (somewhat loosely informed) intuition suggests to me that in the same way that not spending enough time exposing the eye to light outdoors increases the severity of myopia, it would likely be causative in those other degenerations. Use it or lose it!
Not that I know anyone who spent all of their childhood with nose in a book then graduated to a computer, cough... I say this having quite mild myopia, although I wear glasses still, can't stand a blurry world.
So I just asked my partner, and what she explained was myopia is basically caused by/a symptom of axial elongation of the eye, which is also what can cause the bigger diseases I spoke about initially! Ortho-K/myopia control as a kid/young adult can help fix/arrest the continued development of this, though thats now well outside what I understand of the topic haha
You're right, defining a "disorder" is hardly a boolean question. ADHD has been studying extensively and there is substantial evidence for biological origins. For one, heritability very high, reported to be somewhere between 0.75 and .9, only slightly less than traits such as height.
Significant differences in brain neurophysiology are well-documented in ADHD (vs. non-ADHD people), and show genesis of the condition is multi-factorial. Calling ADHD a "disorder" implies the condition has physiological origins but is not attributable to a narrow/distinct range of factors like a condition termed a "disease" (such as viral illness, etc.).
The issue of diagnosis conceptually reflects a state where "malfunction" and "maladjustment" or "maladaptation" coincide. IOW malfunction is relevant when it's maladaptive, that is lacks fitness to a problem-space. In a computer application a bug (malfunction) can lurk undetected as long as the code containing the error is not invoked. But when some refactoring exposes the bad code to invocation, that code is maladaptive and the result is dysfunction of the application.
An example is an ADHD individual with trouble prioritizing who takes longer than peers to complete tasks. Not a problem when deadlines are minimal. But thrust into a role where timely performance is required risks failure, loss of a job, etc. The individual's malfunction is then maladaptive, which could prompt the person to seek help to mitigate malfunction and improve adaptability to realities of employment.
Consequently there's no across the board right or wrong answer to the "correct" way to regard ADHD characteristics. Also I agree with you that "mental illness" is a misleading term that could profitably be expunged from our vocabulary. However were that to happen the conditions that are labeled as such are still very real and will in many cases continue to need treatment regardless of the labels we apply.
> <X> is part of the natural variation in how human brains work, and ... it's a category error to think of it as a malfunction to be repaired
No! No one is saying that everyone at one end of the spectrum has a disorder. It is specifically not a category error because the term "disorder" is not applied based on the variability, but rather based on whether the variation meaningfully disrupts the individual's life.
That's why the only change the author needs to make here is to say he has an attention deficit rather than saying he has a disorder.
But that exact same person in a different time, place, or career, might not be disrupted. I wasn't diagnosed until recently. The compounding of increasing demands at home with my family and at work, partially due to pandemic side effects lead to it. A hunter gatherer might actually gain benefits from it. Its like saying someone who is very tall has a disorder because it makes them a poor horse jockey, or a very short person has a disorder due to the impact on their NBA career.
> But that exact same person in a different time, place, or career, might not be disrupted.
If you are not disrupted, you do not have a disorder. Psychiatric medicine is about you and how you feel about it. If you feel like you can make a life change and have it not impact you, great! Do that.
> A hunter gatherer might actually [...]
That's nice, but it's not what you are and not how your life currently looks. So why do you think it's relevant? I don't understand this reference.
> Its like saying someone who is very tall has a disorder because it makes them a poor horse jockey
It is not, because this is about mental quirks that impact your life to such an extent that you feel you cannot adequately live it.
No. Again: the diagnostic criteria are not this simple, and it's a strawman to argue against something that isn't happening. Diagnosis requires disruption across multiple areas of one's life—not just an inability to be successful at the highest competitive levels in a specific skill.
I would just add that I like to refer to it as "attention dysregulation" rather than 'deficit'... my experience I can focus on one singular task to the exclusion of all other needs and demands (even base biological ones), to point of being in pain and exhaustion and causing myself harm.
Staying up for 40 hours programming... running trails for hours and hours... I have more than enough attention.
That’s a major reason why Dr. Russell Barkley refers to it as Executive Function Disorder. We actually don’t have a problem with attention; we have a problem prioritizing what we attend to. Everyone with ADHD is familiar with the hyperfocus phenomenon. We can pay attention (even sustained, abnormally intense attention) to activities that provide a healthy dopamine payout, but we don’t really control what those activities are. It’s helpful if they happen to be socially useful activities!
Yes! I've been slowly getting into his work on the various executive functions, not just the intellectual/thinking one... emotional regulation is a big thing too!
Honestly, the emotional regulation component is one of the biggest things for me, as anyone who has ridden with me driving could tell you…
But learning to see it as an executive function disorder that really touches on a whole host of other cognitive functions beyond just attention has been a real game-changer for me in terms of conceptualizing the disorder. It makes it more overwhelming on some level, but it also helps to explain many of the struggles I have beyond just paying attention (which, as we know, often isn’t the major problem we face).
(Excuse the google link, its a direct PDF file download annoyingly)
> Be aware that it is common for the experiences
of Aboriginal people (such as seeing spirits or hearing voices
of deceased loved ones) to be misdiagnosed or mislabelled as
mental illness when they are not in fact ill. Fear of misdiagnosis
can be a strong barrier to help-seeking for Aboriginal people.
For these reasons, you should take great care not to simply
assume that the person is developing a mental illness or
suffering a mental health crisis.
That said it can be incredibly hard to medicate someone in psychosis, especially if there's an aspect of paranoia.
And even then, the medications are generally only somewhat effective, which can be a world of improvement, but still leave the person in a state of psychosis.
And that leaves accommodations: in the US, it's hard to get a psychotic disorder like schizophrenia covered by disability insurance. Workplace accommodations are near impossible.
Even medical professionals can present difficulty, if they're not familiar with the implications of being in such a psychotic state.
And anything done to improve the situation can easily be misconstrued and in fact make their mental state worse.
A good analogy would be height: a person who is several standard deviations from the mean will face challenges in life that require various forms of intervention, but we don't generally think of them as having a _disorder_ unless there's an identifiable biological cause that usually has other effects.
Another good point of comparison is vision. We can accurately measure vision and create medical devices to correct unwanted variation. As someone with myopia, I find it to be only slightly medicalized -- going to get an eye exam doesn't feel much like visiting a doctor, and people don't tend to talk about it as one does a medical condition. I imagine that if we were able to make a similar kind of standardized assessment of whatever neurological basis there is for ADHD, we would consider medication for it more akin to a stepladder or a pair of glasses (or even an antihistamine) than a treatment for a mental illness.