ADHD: Ignorance or Bell Curve Bullshit?

Almost every day you can read about ADHD in the headlines, and its seldom that it’s good news, mostly it’s garbage or agendas being spewed. I’m fed up, here’s my opinion …

Let’s look at the evidence, shall we?

“… just one end of the a bell curve …”

Statements from the article:

1. “Part of the confusion stems from how ADHD is described and categorized as a “disorder.” Most textbooks or official websites state that ADHD is a neurodevelopmental disorder, portraying it as an abnormal brain condition with specific causes.“
2. “The phrasing of such explanations creates the impression that ADHD is a “thing” that you either “have” or don’t have. This inevitably leads to endless debate about whether it’s a “real thing” and whether a particular individual really “has” the condition or not.“
3. “It’s been known for a long time that ADHD is not only a deficit of attention. Attentional control is just one of several executive functions, though an important one. Each of us falls somewhere along that bell curve of executive function (EF), having varying degrees of intensity of EF–just as with most human traits (analogous to the IQ bell curve). People meeting the criteria for a diagnosis of ADHD are (in most cases) simply those whose EF is further toward the left end of that bell curve.“

UPDATE – 2022-08-27: New research just released on White Matter, which again provides scientific proof, that the maturational delay the causes the behaviors of ADHD, can be SEEN on brain imaging scans across three age-stages, 17, 20 and 25 years of age.

My reply …

1. Order vs. Dis-order. Disorder is when something is not working in the order it is supposed to. In the case of ADHD, it is scientifically proven, that a brain of a person with ADHD, physically develops with a 30-40% delay in cortical maturation, especially of the parts of the brain that houses The Executive Functions. So when the author tries to disregard this proven scientific fact (Shaw et al., 2007), he is not only displaying his ignorance, he is also showing us his true intentions – to create doubt about established facts.
2. Have or have-not. Can we agree on one thing? Is it true, that you are either born with blue eyes or not born with blue eyes? It is genetically determined and you have no influence on whether or not, you are born with … blue eyes, right?
   94- 96% of the traits that defines the behavior that is associated with ADHD, has been linked back to the clinical ADHD diagnosis, with genetic correlations ranging between 0.94 and 0.96 (Franke et al, 2021), which proves that these are not a CHOICE, and nor is learned behavior or a psychosocial symptom of bad parenting! “whether an individual has it or not” is no a choice, it’s a fact of life, for me and millions of others with ADHD.
3. Not only a deficit of attention. Correct! ADHD has nothing to do with attention! What is the underlying cause is the executive function Inhibition, with it sub-executive components, Response Inhibition and Interference Control.
   In his book “Executive Functions – What They Are, How They Work, and Why They Evolved” (Barkley, 2012), my friend and (unofficial) mentor, writes: “The theory of evolution provides a means by which one can understand the functional mechanisms that species have evolved to deal with problems they encounter in their environment—these functional mechanisms are their adaptations. The EF system is a complex functional mechanism that seems to have been designed for a purpose—it and the PFC that gives rise to it are costly. Such costly adaptations do not arise in evolution without providing their owners with some benefit to their survival, chances of reproduction, and inclusive fitness (the likelihood that their genes and those shared with relatives get into the next generation). EF is an adaptation that has evolved to solve a problem or set of problems faced by those few species that possess it. This is not a non sequitur—EF may have evolved to solve social problems. Humans are a social species, and living with other genetically related and unrelated individuals poses problems (and opportunities) for members of that species. There is a daily need to look ahead and anticipate what others are likely to do in the context of pursuing one’s self-interests. We can rightly ask what specific adaptive problems the EFs evolved to solve in the environmental niche in which humans live. It surely was not sorting cards.“.
   
   The first principal of (self)control is:
   — STOP — THINK — EVALUATE — EXECUTE!
   What ADHD does, is disregard the first 3 steps in this process, since the cortical maturational delay is causing our inhibitory functions to be … dysfunctional! Barkley have coined the term “Executive Age” referring to the 30% delay in development of age-appropriate executive functions, which means that an unmedicated child with ADHD of age 10, has the inhibitory control of a 7-year old, since the maturational delay puts the child’s performance at the level of a 7-year old, not a 10 year old! So when the author proclaims that ADHD is not a disorder, but just an end of a bell curve … he displays his ignorance, and exposes his real agenda … dis-credit, dis-inform, dis-tort, and dis-trust.

Bell Curve Bullshit

Now, let’s take a look at my radar graph, Bell Curve Bullshit as I’ve coined it … This represent two datasets of MMPI-2-RF Profiles, the GOLD STANDARD in psychometric testing.

I have conducted research of more than 100 adults with ADHD, and I have created a Unisex MMPI-2-RF Profile called ADDspeaker, which represents the median scores of 100 profiles (all validity checked and verified), across the 51 clinical and substantive scales of MMPI-2-RF, as well as 44 additional research scales that I have used to gain the latest scientific insights. In the graph below, it is represented by the blue line.

The Normative Group is the Comparison Groups from the MMPI-2-RF Technical Manual, 39 in all, which is based on 1138 neurotypical adults and their test scores. These represent the “bell curve” and is depicted as the yellow line..

The values in this graph, is T-score. A T-score is a psychometric measurement that enable us to compare test scores across psychometric tests, as well as in-between groups, while still maintaining scientific validity in the scoring results.

A T-score has a mean of 50 (which is normative/neurotypical), and a T-score of 65 is the clinical cutoff for MMPI-2-RF, but even from 55 and up, significant dysfunction has been detected.

The first 4; Somatic/Cognitive, Emotion, Thought and Interpersonal are all MMPI-2-RF standard scales, and as you can see, the blue line is ways off, from the yellow line here. This depicts that, on average, the ADDspeaker group is significantly impaired, as compared to Normative Sample.

The next is Rumination, a classic term used in Psychology to explain “racing thoughts, mind wandering, day-dreaming” etc., again the impairment is clearly visible.

The next 6 scales are from the latest release of ICD-11, which was implemented on January 1, 2022, and these scales are those who replace the old Personality Disorders diagnosis from ICD-10 and still in use in DSM-5.

Negative Affectivity refers to the inability to emotionally self-control and emotionally self-regulate, also called Emotional Dysfunction.

Detachment refers to the psychosocial concept of Attachment, but reversed. It measure your level of Attachment impairment, and is termed Detachment in ICD-11.

Disinhibition refers to Inhibition and it measures the level of inhibitory dysfunction, called Disinhibition.

Dissociality refers to antisocial behaviors and traits, primarily associated with impulsivity and reward postponement.

Anankastia is what is called Obsessive-Compulsive Disorder in DSM-5 today, and it refers to the perfectionistic, inflexible and ritual/rule governed behavior and thinking, which is hindering normal societal performance.

Borderline-pattern is the last from ICD-11 and it is not a clinical diagnosis anymore, but it can be added to one of the five previous diagnoses, to describe the specific behaviors associated with Borderline symptoms.

The last two are ADHD and ComplexPTSD, and these are likewise based on the new diagnosis criterias from ICD-11.

If you are not impaired by your own bias, it should be abundantly obvious, that ADHD is not “just” a bit off to the one end of the bell curve … IT’S NOT EVEN ON THE BELL CURVE!

CONCLUSION

My simple question to the author of this article is … how do YOU define the word “just”?

If you look at my Bell Curve Bullshit graph and examine the gaps between a clinically diagnosed group of 100 adults with ADHD and the Normative Sample …

How does your “just” scale of impairment, different executive functionality etc., now “taste”?

… Enjoy your s**t sandwich …

/ADDspeaker

References

Damatac, C. G., Soheili-Nezhad, S., Blazquez Freches, G., Zwiers, M. P., de Bruijn, S., Ikde, S., Portengen, C. M., Abelmann, A. C., Dammers, J. T., van Rooij, D., Akkermans, S., Naaijen, J., Franke, B., Buitelaar, J. K., Beckmann, C. F., & Sprooten, E. (2022). Longitudinal changes of ADHD symptoms in association with white matter microstructure: A tract-specific fixel-based analysis. NeuroImage. Clinical, 35, 103057. https://doi.org/10.1016/j.nicl.2022.103057

Li, T., Franke, B., AriasVasquez, A., & Mota, N. R. (2021). Mapping relationships between ADHD genetic liability, stressful life events, and ADHD symptoms in healthy adults. American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics, 186(4), 242–250. https://doi.org/10.1002/ajmg.b.32828

Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., Clasen, L., Evans, A., Giedd, J., & Rapoport, J. L. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences of the United States of America, 104(49), 19649–19654. https://doi.org/10.1073/pnas.0707741104