The ADHD myth: what was Leon Eisenberg really saying before he died?

On September 15, 2009, Leon Eisenberg, an American psychiatrist of great renown and prestige, died of cancer.

Some time later, notably in 2012, the newspaper Der Spiegel would provoke a great controversy by publishing an article derived from the last interview offered by Mr. Eisenberg, identifying the professional as the discoverer of ADHD and indicating in the article that the famous psychiatrist had recognized that attention deficit hyperactivity disorder or ADHD was an invented disease.

Before we focus on the controversy raised by such an alleged statement, let us remember what we are talking about when we talk about ADHD.

Attention Deficit Hyperactivity Disorder: What Are We Talking About?

It is understood by ADHD a set of diverse symptoms that have clustered around inattention, hyperactivity and impulsivity, Present stably for a period of at least six months.

Symptoms of ADHD

For the diagnosis of ADHD, they have been shown to have at least six or more inattentive symptoms (lack of attention to detail, difficulty maintaining attention, a busy mind that prevents you from listening, no realization or following tasks or instructions due to distraction, organizational difficulties, loss of items, avoidance of tasks sustained over time, easy distraction, forgetfulness of daily activities) and / or six symptoms of hyperactivity and ‘impulsivity (constant play, getting up in circumstances where you have to stay seated, motor restlessness, excessive speaking, difficulty taking turns, interrupting other people’s activities, anticipating the other’s response in an ending conversation phrases from others, inability to play quietly, run in inappropriate situations).

Some of these symptoms may appear normal at certain ages, but for the diagnosis of ADHD they should be maintained for six months at a degree that does not correspond to the subject’s level of development, given the age and intellectual level. . subject level. In other words, in the diagnosis it is or should be taken into account that the symptoms occur in an abnormal or exaggerated way. It is also taken into account that the symptoms are not found in a single environment or situation, but occur in a generalized way in at least two different environments (thus excluding that they only occurred at school) and result in a marked deterioration in the activities of the individual.

While for its diagnosis there must have been certain symptoms before the age of seven, Attention Deficit Hyperactivity Disorder can be diagnosed at any age, including adulthood.

In this last aspect, it should be considered that although certain aspects of ADHD seem to be corrected with age (depending on whether the frontal cerebral maturation takes place, that in this disorder is generally slowed down), especially in the case of symptoms. hyperactivity, in many untreated cases, some symptoms persist, such as decreased attention span and a certain feeling of inner turmoil.

Leon Eisenberg: Why is he called the discoverer of ADHD?

Numerous publications seem to indicate that what Mr. Eisenberg was the discoverer of ADHD. This consideration is not entirely correct: although Dr Eisenberg has been very relevant in the study of this disorder, ADHD is a disorder known since ancient times, having references to symptoms and trying to be explained. by previous authors, although it has been called in different ways. . In fact, the “discoverer of ADHD” himself once indicated that the disorder was well known before working on it: there are references to children showing the same symptoms since 1902 by George Still (who would classify them as children). moral control) and even earlier descriptions.

Despite this, Sr. Eisenberg played a very important role in taking this disorder into account.: He was a pioneer in giving due importance to genetic factors in the etiology of this disorder (before he and other authors advanced their research from a more biological and neuroanatomical point of view, some of the explanations etiological of the disorder have socio-emotional connection with the parents, in particular with the mother, with whom the parents were partly responsible for the disorder of their child), as well as the introduction of ADHD in the reference manual of psychiatry and of American Psychology, the Diagnostic and Statistical Manual of Mental Disorders or DSM. It was this latter fact that probably led Leon Eisenberg to be sometimes called the discoverer of ADHD.

Article of discord

That said, let’s refocus our attention on the subject of the origin of this article: the alleged confession of its non-existence. In the article published in the newspaper Der Spiegel, the words of the interviewee seem clear, but they appear decontextualized, being easy to distort the meaning they had in their initial context. In fact, part of the problem is based on a misinterpretation of the meaning of words in their English-German translation. The interview in question was more about examining the increase in diagnoses of mental disorders in recent times.

With a more contextualized look at the interview situation, it is possible to observe that the criticism of the so-called ADHD discoverer centered on the dramatic increase in the number of new suspected cases of the problem.

like that, the well-known psychiatrist spoke of the overdiagnosis of this disorder, These are often pharmacological cases in which the disorder does not exist and in which, if there are symptoms, these may be due to psychosocial factors, such as parental divorce, changes in place or lifestyle or other personal losses (in this case there should be no talk about ADHD unless it is a problem unrelated to the vital events in question).

Another critical point is the excessive tendency to prescribe drugs, because while it can be of great help to those who suffer from it, it can be detrimental if given to people without this disorder. In addition, the fact that they are usually minor should be taken into account, so special care should be taken when administering psychotropic drugs. Additionally, in the same interview, he indicated that while there is some evidence of some genetic predisposition to the disorder, it has been overestimated, requiring more research into psychosocial causes.

A critique of overdiagnosis

In conclusion, we can consider that the article claiming that Dr. Eisenberg denied the existence of ADHD is the product of a misinterpretation of his words, Not having indicated to the psychiatrist that the disorder does not exist but is diagnosed with excessive haste, making the diagnosis in cases which do not suffer.

Bibliographical references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Barkley, R. (2006). Attention Deficit Hyperactivity Disorder, Third Edition: Handbook for Diagnosis and Treatment, Guildford Publications. New York.
  • Eisenberg, L. (2007). Commentary with a historical perspective from a child psychiatrist: when “ADHD” was “the child damaged in the brain”. Journal of Child and Adolescent Psychopharmacology, 17 (3): 279-283.
  • Grolle, J. and Samiha S. (2012). “” What about tutoring rather than pills? “Der Spiegel. 02.10.2012
  • Miranda, A., Jarque, S., Soriano, M. (1999) Attention deficit hyperactivity disorder: current controversies over its definition, epidemiology, etiological bases and intervention approaches. REV Neurol 1999; 28 (Suppl 2): ​​S 182-8.
  • Von Blech, J. (2012). “Shameless Sadness”. The mirror. 06/02/2012.

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