Welcome to Entanglements. In this episode, hosts Brooke Borel and Anna Rothschild ask: Is ADHD a disorder? The condition affects millions of people around the world, and their symptoms are certainly real. But scientists are not in agreement whether or not to call ADHD a true disorder.
Their guests this week are Barbara Franke, a professor of molecular psychiatry at Radboud University in the Netherlands, and Edmund Sonuga-Barke, a developmental psychologist and a professor at King’s College London.
Below is the full transcript of the podcast, lightly edited for clarity. You can also subscribe to Entanglements on Apple Podcasts and Spotify.
Brooke Borel: Hey, Anna.
Anna Rothschild: Hey, Brooke
Brooke Borel: Out of curiosity, do you know anyone who has ADHD?
Anna Rothschild: Uh, I would say like almost all of my best friends have ADHD.
Brooke Borel: Yes, I also know many people who have ADHD — friends, family, etc. And it’s not surprising, right? Around 22 million people have been diagnosed with ADHD in the United States alone, and currently about one in nine kids get diagnosed with it at some point in their childhood.
Anna Rothschild: That is wild.
Brooke Borel: Totally. And you know what’s even more wild? Even though all these people have it, scientists still can’t agree on what ADHD even is.
[MUSIC]
Welcome to Entanglements, the show where we dig into the thorniest scientific debates and try to find common ground. I’m Brooke Borel, articles editor at Undark Magazine.
Anna Rothschild: And I’m science journalist Anna Rothschild. All right, Brooke, so what is going on with ADHD?
Brooke Borel: OK, so ADHD stands for attention deficit hyperactivity disorder. It’s listed as a neurodevelopmental disorder in the current DSM, the Diagnostic and Statistical Manual of Mental Disorders.
Anna Rothschild: Basically the bible of mental health disorders.
Brooke Borel: Right. And people diagnosed with ADHD may have trouble paying attention. They might be really impulsive or hyperactive, and as a result they have trouble functioning in certain settings, like at home or at school or at work.
Anna Rothschild: OK, I’m with you so far, but there is a ton of scientific research on ADHD, right? Like, how is this still an open question?
Brooke Borel: Absolutely, you are correct. Scientists have long been looking for the biological underpinnings of ADHD, like the genetics or potential brain differences, but there’s a growing discussion on whether all that data really shows that this is a disorder.
Anna Rothschild: I mean, I don’t want to invalidate the experience of 22 million right?
Brooke Borel: Me either.
Anna Rothschild: Like, surely we both have friends and relatives who have really struggled because of their ADHD.
Brooke Borel: Absolutely 100 percent. The group of symptoms that we call ADHD is obviously real, and people are genuinely affected by it. That’s not up for debate. But whether we should call it a disorder with a discrete underlying biological cause is not so clear. So we’re going to get into all of that. For today’s show, I asked a molecular biologist and a developmental psychologist to weigh in, and the conversation was fascinating.
Brooke Borel: So the question of the day is: Is ADHD a disorder?
Barbara Franke: Yes. For me, ADHD is a disorder. because many people who have ADHD suffer.
Brooke Borel: This is Barbara Franke. She’s a professor of molecular psychiatry at Radboud University in the Netherlands, and she’s also the head of the Department of Medical Neuroscience at the university’s medical center. And she studies the biology of psychiatric conditions and particularly the underlying biology and genetics of ADHD.
Brooke Borel: When you consider it as a disorder, like how do we even define disorders more broadly?
Barbara Franke: A disorder is for me defined by the fact that a person has both symptoms and that these symptoms interfere with the functioning of this person. And for ADHD in particular, it means that you have symptoms of inattention and or hyperactivity, impulsivity, and that you experience impairment from these symptoms in your daily life.
Brooke Borel: Barbara acknowledges that diagnosing ADHD is tricky, though, because identifying those symptoms in a person is not totally straightforward.
Barbara Franke: ADHD is diagnosed based on clinical interviews, on questionnaires to people next to those with the potential diagnosis. So there are criteria to say somebody has ADHD or somebody hasn’t got ADHD. The fact remains that there are no objective tests to really find out if somebody has ADHD.
Anna Rothschild: OK, and those symptoms and behaviors would be things like what you mentioned before, like having trouble paying attention, being really impulsive or hyperactive, that kind of thing?
Brooke Borel: Right. But to get an official diagnosis, a person has to actually experience symptoms, not just in one setting, but in at least two. So for example, they have to be struggling both at home and at school or at home and at work.
Anna Rothschild: Gotcha. So what Barbara’s saying is you can’t look at someone’s brain and say for sure that they have ADHD or not. For now, doctors are just looking at how someone interacts with their environment and they assess them for ADHD that way.
Brooke Borel: Yeah, that’s the case for now. But there’s at least some research looking into the biological underpinnings of ADHD. So for instance, doctors say there are three distinct types of ADHD based on people’s behaviors. And scientists recently identified three roughly matching types of ADHD based on brain scans and brain chemistry. And Barbara is looking for hints about what might be happening genetically.
Barbara Franke: We know that ADHD is partly heritable, but the heritability of ADHD is quite complex so it means that multiple genetic factors, multiple genes are involved in ADHD, and only if you have a certain number of genetic risk factors in your DNA, you’re going to develop ADHD.
Brooke Borel: How many genes have been identified that might be related to ADHD?
Barbara Franke: For now, we know between about 100 and 200. We expect that there will be several thousand. And what is very important is that the effects of individual genes are very, very small and only if you have many of these slightly off functioning genes, you will be at increased risk of developing ADHD.
Brooke Borel: Scientists like Barbara identify these genes using genome-wide association studies, or GWAS. These use enormous sets of data to try and tease out genetic variations that might relate to a specific disorder or disease or trait.
These studies have limitations, though. They can’t prove a direct causal link between a specific gene and a disorder. The individual genetic influence on a specific disorder can also be very, very small, so it’s hard to know for sure what’s truly contributing and what isn’t. Although if you have a large enough data set, you can start to see stronger patterns, and ADHD isn’t an anomaly in that sense.
Brooke Borel: What are some examples?
Barbara Franke: Well, schizophrenia, bipolar disorder, depression, PTSD, autism, Tourette syndrome, anxiety, you name it.
Brooke Borel: So we’re trying to find genetic components for all of those, and all of those are very difficult because it’s a lot of genes contributing a little bit and these can manifest in different ways for different people. So ADHD is not unusual in sort of defining it as a disorder using these techniques.
Barbara Franke: No. The same counts for, also — going beyond psychiatry for Alzheimer’s disease, for many neurological diseases, migraine, etc. Epilepsy.
Anna Rothschild: OK, so her point is you don’t have to know what causes something on a biological level to know it’s a disorder.
Brooke Borel: Right. And there are all these other disorders like schizophrenia and Alzheimer’s that we also identify in a sort of loose way, and most people are not disputing that those are genuine disorders.
Anna Rothschild: Right.
Brooke Borel: What kind of data or evidence would you need to see to be convinced, like, well, maybe this isn’t a disorder, maybe this isn’t so clearly a specific disorder.
Barbara Franke: Well, if I say it is a disorder, I’m taking an extreme view. For ADHD, it’s clear that it is a problem that people have with finding their way in society. Is it then in the person or is it in society that the problem lies?
Brooke Borel: Hmm.
Barbara Franke: And I think both, is the case, and what you see is that some people find niches in society where they are not so much troubled by the symptoms that belong to ADHD. So I’m hoping that at a certain point people will not be bothered anymore so very much by their symptoms, so that we have created a society where people with ADHD can use their strength, which they clearly have, and are not bothered by the limitations that they have.
Brooke Borel: So what are some examples of how that could look?
Barbara Franke: Well, we see it for example — there’s a surprising number of athletes that have ADHD. There’s a surprising number of entrepreneurs that have ADHD. Actors often have ADHD. So there is a lot of energy in these people. But they need help in organizing themselves. If they have that, they can be very successful. So making the context fit to the person that has ADHD is very important.
Brooke Borel: So when you consider this as a disorder, you’re not just thinking of it as this is something that we can identify in the brain and the genes as a disorder. You’re also considering it in the context of society. Like it’s a disorder in part because society is not built for — like a school setting, for example, is not really set up for a child who has ADHD to succeed.
Anna Rothschild: So in a way, Barbara’s definition of disorder is focused on identifying and treating people who suffer rather than on some strict biological understanding.
Brooke Borel: Yeah, and Barbara also pointed out that if we don’t think of ADHD as a disorder, then people who really do need support at school or at work might not get it. So if you don’t have a disorder, there isn’t an insurance code for you to get the medication or access to the institutional levers that get you more time on a test at school.
Anna Rothschild: So like a systemic problem. We need to have a disorder to get services.
Brooke Borel: Exactly. But now let’s hear a different point of view. Our next guest has also been doing basic research on ADHD for a very long time, since the late 1980s. He used to agree with Barbara, but his views on whether this is a disorder have changed drastically over time.
[MUSIC]
Brooke Borel: So for this episode, the question of the day is: Is ADHD a disorder?
Edmund Sonuga-Barke: Very, very, very good question, and it’s something I’ve thought about a lot. I would say, it’s not useful to think of ADHD as a disorder.
Brooke Borel: And why not?
Edmund Sonuga-Barke: Because it doesn’t have any of the hallmarks of a medical condition.
Brooke Borel: This is Edmund Sonuga-Barke, and he is a developmental psychologist and a professor at King’s College London. Edmund went on to explain three defining hallmarks of a disorder. And ADHD, he says, doesn’t meet any of them.
Edmund Sonuga-Barke: It’s not a discrete entity — it’s a genuine continuum within the population. So obviously ADHD symptoms are spread across the population. But what we’ve shown in our research and in other people’s research: there isn’t a point on that continuum, which you could say ADHD exists on one side of that point and ADHD doesn’t exist the other side of that point. There’s no point in which there’s a step change, say, in brain structure and function, or even in impairment or negative consequences of the disorder.
Brooke Borel: The second thing that disqualifies ADHD as a disorder, according to Edmond, is that when it comes to the brain, there is no specific change or difference in the brain that is common across all people who have ADHD.
Edmund Sonuga-Barke: The brain imaging data now is really quite clear that ADHD is an incredibly heterogeneous condition, so there isn’t just one underlying cause. There isn’t a single, distinguishing sort of brain profile.
Brooke Borel: The third issue is that when it comes to the genetics, the brain biology, and the cognitive outcomes, ADHD overlaps with a number of other conditions. For instance, there are a lot of similarities between people with ADHD and autism, and the biology as it’s currently understood is all just kind of messy.
Edmund Sonuga-Barke: On balance now — and this is from the science — this isn’t just me being against medical disorders or medical formulations of psychiatric difficulties. It’s — you know, I used to be much more in favor of them.
Brooke Borel: Yeah, I wanted to ask that actually. Because you haven’t always — this is a newer development in your career as far as I understand. What evidence or data changed your mind and convinced you that ADHD shouldn’t be considered a disorder?
Edmund Sonuga-Barke: I think there’s each of those caveats I mentioned — continuum, heterogeneity, non- specificity or overlap — were of a key defining moment.
So in terms of the continuum, rather than the category, I would say I have been fascinated by that for a long time. We reviewed the data, and we can’t find that boundary. And then when you look at the rest of the studies that have been done in the sort of taxometric tradition in ADHD, none of them can find a boundary.
Secondly, heterogeneity. So, way back, I’d been thinking about this. And that goes back to like 2002, we published a paper. Basically we looked at two possible explanations for ADHD. One was around executive dysfunction, cognitive control. The other was more around motivation, we’ll call it delay aversion. And we thought, well, one of these must be right. Because ADHD is a singular thing, it’s got a singular sort of cause. And when we did that, with a big sample, we found out they’re both explaining ADHD, but they weren’t related to each other. And that was the first sign that ADHD was fundamentally heterogeneous.
I was thinking, well, maybe these are subtypes of this category. You know, with the data on the continuity as well that came together thinking, well, maybe, you know, actually thinking of it as a categorical disorder just isn’t the way go.
And then the final one of overlap, that’s really come through in the last 10 years. So these massive genetic studies they’ve basically shown very high overlap in terms of the correlates of a whole range of conditions and disorders. For instance, shared genes for autism and ADHD, shared brain alterations for autism and ADHD. And so again, really, highlighting the lack of specificity, for these two conditions. So I think those three things came together. And so that’s when I kind of switched from thinking of it as a disorder.
Brooke Borel: If ADHD isn’t a disorder, what is it?
Edmund Sonuga-Barke: OK. If ADHD isn’t a disorder, one way to think about it would be as a biological risk, a biologically determined neurodevelopmental risk. And that’s a continuum which would predict certain negative outcomes.
Brooke Borel: And when you say negative outcomes, do you mean like certain behaviors or certain difficulties and —
Edmund Sonuga-Barke: — academic underachievement, —
Brooke Borel: Mm-hmm.
Edmund Sonuga-Barke: — marital failure, vocational instability, etc. You know, I think a key distinction is conceptual between the notion of a medical disorder and an underlying neurobiological risk trait. So it’s not disordered in and of itself. It’s a predictor of difficulties later in life.
Brooke Borel: And so what’s at stake? Why does this label matter one way or the other?
Edmund Sonuga-Barke: I think there are a number of things at stake. And obviously these are really big questions, I’ve been trying to think about them as sophisticated as I can. So I guess the concept of a disorder order frames the research. So when you assume a disorder, then you look for the cause of the disorder. If you didn’t, it’d be totally illogical as a scientist. So I think removing the concept of disorder, having a much more neutral framing in terms of risk, or even a more positive framing more variable framing in terms of negatives and positives opens up science. It sort of gives permission to study other things, like strengths, like flourishing, rather than sort of the disaster narrative around ADHD that’s clearly existed: “If you’ve got ADHD it’s going to be a disaster.” Well that’s not true, of course.
Of course lots of people with ADHD do really, really well, and exploit their natural tendencies, to hyper curiosity or energy or enthusiasm or sense of humor or whatever. Hyperfocus is a trendy term, but I think it’s a reality. You know, they actually exploit them to thrive and to flourish. So I think it opens all that up, in the research community, which is the bit I’m primarily interested in, because I’m primarily a scientist. But I also think, the disorder term impacts the way people with ADHD think about themselves, not surprisingly. If you’re saying that somebody’s brain isn’t different, it’s actually broken or disordered, then that’s quite a strong message.
Anna Rothschild: So this seems like not just an argument over the scientific evidence or semantics, but almost a philosophical debate, right?
Brooke Borel: Yeah.
Anna Rothschild: Like what is the purpose of labeling something as a disorder? Is the label primarily for scientists or for the people experiencing or suffering from the condition? Or can it be for both?
Brooke Borel: Exactly. If the underlying biology isn’t clearly “disordered,” and the word itself indicates some sort of problem, should we have different language around it? And also, if we have different language around ADHD, could that open up a whole new realm of possible research?
Anna Rothschild: Yeah, Edmund said something about research on flourishing with ADHD.
Brooke Borel: Yeah. So if most of the research currently is looking for the underlying causes of this apparent disorder and also looking at all the ways in which people are impaired by it, is there also room for research on the ways in which ADHD can help people really thrive?
Anna Rothschild: I am so curious to hear what Barbara thinks about this take.
Brooke Borel: Here you go!
[MUSIC]
Edmund Sonuga-Barke: How are you doing?
Barbara Franke: Good, and you?
Edmund Sonuga-Barke: Good, thanks. Nice to see you. I think the last time we were together, we had a dance, didn’t we. Do you remember…
Brooke Borel: I do wish more scientists were out dancing together. That’s amazing.
Edmund Sonuga-Barke: It was at the, I think it was called the Blues Kitchen in Shoreditch in London. It was fun.
Brooke Borel: Then we jumped right in. I asked Barbara what she thought about Edmund’s three hallmarks of a condition and the fact that he doesn’t think ADHD meets any of them.
Barbara Franke: In principle, I can agree with Edmond totally. But the interpretation of those would be for me still that there is a disorder.
Brooke Borel: And why is that? Why is that different? You’re looking at the same things.
Barbara Franke: Yeah. We indeed know that there is a continuum, in many ways. But you have a clinical extreme on that continuum. And this extreme of the continuum has implications for functioning of people in society, and causes impairment. So from that point of view, and knowing how strongly the ADHD community has fought to be acknowledged as needing help, my answer would still be this is a disorder.
Edmund Sonuga-Barke: Yeah. So, thank you Barbara, that’s really interesting. What you’re saying is kind of what we discussed as well last time. Basically the science sort of highlights some of the untenable aspects of the disorder concept. There isn’t a distinctive differentiating pattern of brain or genetic variation that suggests an entity like a disorder, but there are people who suffer from extreme levels of inattention, overactivity, and hyperactivity. So I think that’s an interesting tension and I think it kind of leaves us with a conundrum. Do we just say the science isn’t important in answering this question? Or do we say, can we recover the more practical clinical aspects so it aligns more with the science?
Barbara Franke: I think, Edmond, there are two things. So the question that I answered was, is ADHD a disorder? And I think the question that you answered was, is ADHD a distinctive disorder? And the “distinctive” makes a lot of difference, I think. If you look at the symptoms, they are not specific to ADHD. The cognitive alterations that you see in some, not all, are not distinctive. The genetics is only partly distinctive. So indeed, if you say, well, does that qualify as an entity, I would say no, and I would be totally on your side. Is it something that is recognizable at a clinical level to a certain extent, and that is treatable with a certain set of medications? I would say yes it is. But if you ask me, is it a biological entity, definitely not. I agree.
Edmund Sonuga-Barke: Yeah. We used to think it was. I mean, that’s the interesting thing. So the whole research agenda was initially the hypothesis that it was a biological entity. And the science has shown it isn’t — it’s much more complex, much more heterogeneous, and so forth. So in a way the mental disorder is a philosophical concept, not a reality. Is it the best way of characterizing the condition and is it useful? Or has it, as in my mind, become a bit of a barrier to progress. And also I guess the notion that people with extreme levels of inattention, impulsiveness, persistent — the phenotype — are disordered? I never used to be worried about that. But the whole neurodiversity thing has made me think again about that. Now, I understand some people do really value the ADHD label or the disorder label. But when you think about it, isn’t it interesting, why would that be the case? See what I mean?
Barbara Franke: Yeah. I would be very happy to say goodbye to the term disorder. For me at the moment, it is a way to get help. If we can disentangle those two, I would be more than absolutely happy to say goodbye to the disorder label.
Brooke Borel: And Edmond in our conversation, you had suggested instead of calling this a disorder, thinking of it as more of a risk factor. Maybe the two of you could talk about that a little bit.
Edmund Sonuga-Barke: I think I used the analogy of the high blood pressure, and its kind of physical consequences and its risk properties. So clearly that does lead to clinical support if you’ve got high blood pressure. Couldn’t we have an equivalent? So you have high levels of inattention, hyperactivity, impulsivity, that’s causing difficulties. And it’s likely to lead to lots of problems. Couldn’t we, I don’t know exactly what the word would be, but couldn’t we frame this as a risk profile rather than, you know, being disordered or your brain being deficient or dysfunctional.
Barbara Franke: Yeah, I would totally agree. But the problems that people with ADHD experience are really in functioning in society. So indeed, ADHD and any other psychiatric condition leads to alterations in functional outcomes. And that is indeed what is the problem.
Brooke Borel: Barbara, in our conversation at one point we had talked about the fact that there are some sort of difficulties in pinpointing ADHD as a thing that’s happening biologically, and I asked you if that was unusual or if there were other conditions where that was also the case, if you look at the scientific data. And you mentioned several, you mentioned PTSD and I think depression and autism and several others. And I guess I was curious if you could both talk about that these are things that we — maybe not all of those things, but that we often label as a or label as something concrete, and that people are often medicated for, for some of these. So maybe you could talk about this distinction there. Like, is ADHD so different from these other examples? Or are none of these disorders? Like at what point is the scientific data like telling us that a lot of things that shouldn’t be labeled that way?
Barbara Franke: Ah.
Edmund Sonuga-Barke: What it does, I guess, because Barbara’s absolutely right, the data in a way that’s coming out of the labs challenges the overall framework for neurodevelopmental problems, or conditions, or whatever you want to call them. Now it’s looking like probably it doesn’t really map onto the biological genetics, and so forth, data. And the challenge is enormous, because how you move from where we are to a framework that does map on better, acknowledging the overlap between these clinical presentations, acknowledging the heterogeneity within them — how you move there, it’s really an absolute paradigm shift.
Barbara Franke: Mm-hmm.
Edmund Sonuga-Barke: I mean, even though my answer to the big question was no, it’s not useful to look at ADHD disorder, I don’t know if we are ready to move to a system where we look at it as something else.
Barbara Franke: Well, for me, I think I’m totally on the same line as Edmond is. And I could find myself totally in saying this is not a disorder if it weren’t for the danger for people not finding the help that they need, because simply politicians say, OK, so if you’re not disordered, then why should we give you extra time for exams? Why should we support medication? And I think that for me makes the point that, that we are not yet there to be able to let go of the disorder term.
Edmund Sonuga-Barke: Very interesting. No, I think we’ve kind of ended up quite close in a way, Barbara? In terms of where we are.
Brooke Borel: It’s really a philosophical question, like it seems like you agree on the science. It’s more like a philosophical question: How do we talk about this in a way that will help people?
Edmund Sonuga-Barke: I think even more than that, it’s how do we transition out of the disorder concept in a way that doesn’t harm people. And I guess we’re waiting for society to catch up, in the way of thinking about ADHD people to then provide opportunities and support so they can thrive and flourish. And that is definitely not there yet. It’s more of a societal change that’s required and whether that ever happens, I don’t know.
[MUSIC]
Brooke Borel: All right, Anna, what do you think?
Anna Rothschild: You know, I will say that this episode has made me somewhat uncomfortable.
Brooke Borel: Tell me more.
Anna Rothschild: I just know a lot of people who have ADHD and have really struggled with it, and who are very tied to the term disorder because they think removing it really invalidates their experience. And I think especially because one of the treatments for ADHD is stimulant medication, which is a contentious thing, removing the term disorder feels to them like people who are seeking treatment are actually just being accused of being like drug seekers.
Brooke Borel: Totally.
Anna Rothschild: You know what I mean?
Brooke Borel: I understand that.
Anna Rothschild: You know, realistically, there are a lot of people out there who are really struggling and need help, and I think for them, they feel like, “Why is this debate making the levers of getting help so difficult to access?”
Brooke Borel: Yeah, I totally get that, and I personally have very close family members who have ADHD diagnoses, and I’ve helped navigate the system in terms of getting them support, right? I am very familiar with the school system and how that works, and if you don’t have a very clear diagnosis, your services go away.
Anna Rothschild: Exactly.
Brooke Borel: And that has absolutely real consequences for people’s lives, and their abilities to function in society and all kinds of things. I do think it’s interesting to think about, and this came up in our autism episode as well, just the way that our society is set up for people who are different. It’s almost like a disease of the society, right? like, if school weren’t so rigid, if work weren’t so rigid in requiring these days to sit in front of a computer for eight hours, 10 hours, whatever. Like, those are not really normal things for humans to have to do anyway, and if you have this, whether we want to call it a disorder or whatever, that makes that all that more difficult, and those expectations a little ridiculous at times, right?
Anna Rothschild: 100 percent. I mean, it all comes back to the social model of disability, right.
Brooke Borel: Yup, exactly.
Anna Rothschild: Which we’ve talked on this show before, where like society and the things we are forced to do by our society are the things that are disabling people with ADHD to some extent, right? And a lot of the things that would help people with ADHD would also help people who don’t have ADHD, you know? Like a lot of changes to the classroom or changes to work environments are just generally things that would make all of our lives sort of better.
Brooke Borel: Yes, so true. I will say that in terms of getting medication and such, I’m curious what you think about Edmond’s suggestion to take away maybe that term disorder, but to replace it with something else that would still probably allow, if there were all these systemic changes, for a medication and such.
Like, if you called it a risk factor. He was using the analogy of a risk factor, I think, for high blood pressure. And obviously that’s a little bit different because unlike with ADHD, you can, you know, do a physical test and find out if someone has high blood pressure, right? But if you have these risk factors, those are still considered part of a medical diagnosis, right?
Anna Rothschild: I think it’s just kind of fraught, you know? And, I think that in a perfect world, we would have a way to get people the medication that they need without including potentially stigmatizing language. But I think for a lot of people with ADHD, they bristle at this because we’re not talking about this for something like bipolar disorder.
Or, like, schizophrenia. Like, even if we don’t have great brain data or genetic data on other types of conditions, even things like Alzheimer’s, no one is trying to take that label away in the same way. And so I think that the medication conversation just kind of gets wrapped up with that.
Brooke Borel: True. Yeah, and you know, there’s been this, this sort of trajectory of ADHD in our culture, ever since it was sort of recognized as a thing, and then there’s this sort of backlash, like too many kids are being diagnosed with this. This isn’t like a real thing. People are being over-diagnosed. Kids are being over-medicated, right? There’s that whole perspective, and it’s, these sort of culture wars over it that people who actually have this disorder or whatever, like really suffer when that’s happening.
Anna Rothschild: Exactly. I think it’s very invalidating or potentially even makes it more difficult for them to get the help they need, get the services they need or the medication they need, because it’s seen as like, “OK, well, this is just not a real thing.”
Brooke Borel: Right.
Anna Rothschild: I think there’s also this question for me about: When is there enough evidence? There are biological studies being done on ADHD, like that one that you mentioned about the subtypes of ADHD and the subtypes of brain scans we’re and like roughly matching to each other.
Brooke Borel: Right, so there’s three known separate sort of behavior profiles three different subtypes of ADHD, and just earlier this year, scientists found these three different brain sort of profiles that match those three types. Right?
Anna Rothschild: Yeah, like match them roughly least. And that’s interesting data. That is persuasive evidence that there is something going on in our biology that relates to what’s happening here, right? And I understand that this is just one study, and more studies need to be done. But I think the question is like, when is it enough? You know what I mean? Like when is it enough? I feel like there are plenty of other things where you go to the doctor for something, and they don’t know what’s causing your stomach ache or whatever, but they believe you that have stomach ache.
Brooke Borel: Totally, and it, this, we could ask this question about all kinds of areas of right? In most cases, there is more science that could be done. No single scientific study can answer all questions. And even the huge bodies of research we have on lots of questions in science aren’t fully answered by that body of research because it’s an ongoing dynamic process.
So yeah, we do have to make a decision at some point on any topic that we’re trying to understand scientifically. When do we feel like we know enough to act? And that’s just sort of a continuing question in science, and it is interesting which “disorders” or issues or whatever get more scrutiny than others when that’s true across the board for scientific research.
Anna Rothschild: Totally. And I mean, I will say, I also don’t want to be so shamey. I think that, that Edmond does have a point here to what we were saying before about like the social model of disability, like it would be nicer if we didn’t include stigmatizing language when we talk about some of these conditions, and we think more broadly about like how to make the world just like better for people with ADHD or better for everyone, right?
Brooke Borel: Yeah, I mean, some people might really feel OK with that word disorder, and for some people it can be quite stigmatizing. Like, there’s something wrong with me versus my brain’s just a little different than what you would say is neurotypical, right? And there are some strengths to that as well, so that’s, I think, in part where he’s coming from.
Anna Rothschild: Totally. And I think also, his point about there being a continuum, there is still a lot we don’t understand. And we probably, as more research is done, will find that all sorts of conditions are on a continuum.
Brooke Borel: Absolutely.
Anna Rothschild: And you know, the brain’s complicated. There’s so much we still don’t know.
Brooke Borel: The brain, it is complicated. Hey, listeners, what do you think about all this? Do you think that ADHD or anything else should be termed as a disorder or not? Does it matter if these biological underpinnings are so clear or not?
Anna Rothschild: And is it a helpful term or is it a harmful term?
Brooke Borel: Yeah, exactly. What do you think?
Anna Rothschild: We would love to hear from you. Please send us an email to [email protected].
Brooke Borel: And that’s it for this episode of Entanglements, brought to you by Undark Magazine, which is published by the Knight Science Journalism Program at MIT. Our amazing producer and editor is Samia Bouzid. This show is fact-checked by Undark deputy editor Jane Reza. Our production editor is Amanda Grennell and Adriana Lacy is our audience engagement editor. Special thanks to our editor-in-chief, Tom Zeller Jr. I’m Brooke Borel
Anna Rothschild: And I’m Anna Rothschild. Thanks for listening. See you next time