Why do we give such credence to metaphorical diseases like ADD, ODD and Asperger's?

Over time medicine has become more and more powerful at determining the biological and/or physiological bases of many ailments, including mental and behavioral ailments. In this context it might be expected that savvy people would be suspicious or hesitant about slapping “disease” labels on people, based solely on their behavior, but modern psychology is apparently not at all hesitant to ascribe the “disease” label to a variety of “disorders” that are defined more or less metaphorically by an individual’s behavior, with little hard scientific evidence to back a physiological basis for the “disease” or “syndrome” label.

One day it may be proved that there are indeed biological bases for these “disorders”, but with psychology’s checkered history in this area why aren’t people more credulous about latching onto these “disease” explanations" for dysfunctional behavior?

make that “less credulous about latching onto these “disease” explanations”

When you have a child with ADD, ADHD, or Asperger’s, then come back and we’ll discuss it. You seem to be implying that these are solely behaviors and not real diagnoses. Maybe you should read up on it and find out what they’re really about. I don’t know much about ODD (Oppositional Defiance Disorder?) so I won’t comment on that.

Ditto. Our son has ADHD, and a preliminary diagnosis of Aspergers. Come spend some time with him unmedicated, then tell me he’s “just a normal 10 year-old boy.” I dare you.

Meanwhile, there’s a guy who’s office is in the next building from mine. I walk past some of his posters every day. Check out some
his work. ADHD, Aspergers and Autism now appear to be in the same disorder family, and Dr. Casanova’s work indicates that there is a neurological basis for them.


There’s no question that some people are extraordinarily distractable, disagreeable, obsessively focused, or bad at reading other people’s body language. The question is why we so readily glom onto the notion of a biological “disease” paradigm in typifying and dealing with these behaviors when there is no hard, scientific basis of proof that these behaviors have some discreet, identifiable physiological basis.

The brain is a complex mechanism that can not be easily be tested. The only way to make a diagnoses without cutting it open and taking pieces out is observing the behavior and the patient’s reaction to medication. My boss’ daughter has ODD and she is a terror without her medication. According to the research most violent criminals have ODD.

Well, one reason I suppose is that a biological etiology for say, autism, is an improvement over that the old “cold mother” cause. Also, I believe that this is the way science works- identify a problem, develop a hypothosis and then prove or disprove it.

Alot of science (and some diseases!) is (are?) new or newish such as antibiotics, HIV, prions, and the whole field of psychology, etc.

I don’t think the particular diagnoses you mentioned should be treated any differently while they are investigated.

Do you think the disorders you mentioned aren’t “real” disorders or are not biological in origin?

Just speaking about ADD, I don’t see it as a disorder as such, but a normal condition. Much like the riskier investemnts you may have in your retirement portfolio, ADD is the riskier elements of Humanity. Those with ADD have the ability to advance humanity in great leaps, but few ADD’ers will actually make this contrubution (such as Einstien and Edison which appear to have ADD). The others basically struggle, or worse fail at life. Humanity is the better for the very few ADD’ers who succede.

What are ADHD. Aspergers and ODD metaphors for?

I’ve never been told that my kids have diseases – they’ve been diagnosed with syndromes. Can you show us where these syndromes are described as disease states?

This is not really my field, but AFAIK there is no known “discreet, identifiable physiological basis” for autism, although there are various theories. It seems likely that there is no one cause for autism. Asperger’s syndrome may or may not be a form of autism, but if it is then it’s no surprise that its cause has been similarly difficult to isolate.

Fragile X Syndrome, now known to be the single most common cause of inherited developmental disability, wasn’t even identified until the late '70s. The gene responsible wasn’t pinned down until 1991. I’m sure the medical community would be very happy if it knew the cause of every form of psychiatric disorder too, but treatment cannot wait until they do.

If you feel that some disorders may be overdiagnosed, especially in children, then that is a valid concern. But a disease isn’t pretend or “metaphorical” (I’m not even sure what you mean by that, actually) just because we don’t know what causes it.

Maybe it’s a good idea to prescribe meds to relieve symptoms of various conditions, even if we haven’t found a biological cause yet. And then of course, continue to try to find if there is a biological cause. Until we do, at least people have a way of relieving their symptoms.

This is not to say that many drugs are not way over-prescribed, IMO. But lets not throw the baby out with the bathwater.

But where do you draw the line at “problem” and “not problem”?

I am sure we will find biological causes for most aspects of everyone’s brain. Just because it is biology doesn’t mean that it is a simple medical question that can be treated with simple medication- especially considering that basic concepts of humanity and identity are involved. It’s all a lot more complicated than a broken arm.

Right now we consider it a “problem” when it gets in the way of a normal life- a very practical definition but not a particularly objective one. According to this thinking we have something that is a disease that must be adressed with treatment in one culture and nothing big in another. There is no equivelent for non-neurological diseases. I’m sorry, but I expect a bit more before I start believing they have all the answers.

Actually, researchers ARE coming closer to finding physiological differences:


However, I would argue against using the term “disease” to describe these conditions. The medical definition of a disease is that it is likely to be progressive if not treated–cancer is a disease because the tumor is likely to continue growing; MS is a disease because the lack of muscle control become prgressively worse. There is no evidence that ADHD/Aspergers/Autism become worse without treatment–they just don’t get better.

One can also argue that depression is “imaginary” because there is no bloodtest or physical test that can determine if a person suffers from depression, yet there are both medical and psychological treatments that have been proven to be effective in treating the symptoms of depression. I would even claim that depression is a normal (albeit exaggerated) mental condition, but it is important to realize that severe depression can make it impossible for a person to live a normal life. Similarly, there is no medical proof for SIDS, nor is there any test to determine if a given child is more likely to die of it than another child, but it is a medically recognized cause of death that happens in every culture on Earth.

As research stands now, there is no firm test that proves that a child has ADHD/Aspergers/Autism, and it is probably true that a lot of kids (and adults) are misdiagnosed as having it. However, in cases where the behavior can prevent the person from living independently, or where there is a high likelihood that the behavior could lead to injury to the patient or to those around them, treatment is warranted. It’s also quite likely that treatment for ADHD is effective for similar-but different–conditions, like Fragile X Syndrome, which CAN be tested for with a simple blood test, but whose treatment is pretty much identical to the treatment for ADHD.

However, I also believe that all possible explanations should be examined, too. Low blood iron or zinc levels can cause ADHD-like behavior, and can be treated with dietary supplements very easily, for example. Treatment should also be geared toward making life better for the individual, not the parents/neighbors/classmates/teachers. In other words, if the behavior is simply disruptive, but does not affect the child’s ability to learn and is not dangerous, it may not need any kind of treatment at all.

Excellent overview! I see your point.

A few questions for the OP, from an MD with ADHD:

–Why must a disorder have “hard, scientific basis of proof” that it has a “discreet, identifiable physiological basis” before we treat it? Do you feel that we should completely understand a particular condition before we treat it with medication? (If so, you’re going to be very disappointed if you ever go to medical school…)

–If a particular behavioral disposition is something that causes big problems in my life, there are medications that have been proven safe and effective in altering that disposition, and nothing else has been shown to do so, why shouldn’t I use them?


If you have some good, peer-reviewed evidence of that, I’d love to see it. (I’m not being facetious–I really would. I have a lot of professional interest in this subject, and I’ve never seen any evidence supporting dietary deficiencies or excesses as a cause of ADHD-like symptoms.)

I may be mistaken, but I don’t think that the OP necessarily disagrees with you on this. He is questioning the application of the “disease” label, but not (explictly) the treatments commonly applied.

Are you freaking kidding? You sound like your from the “all they need is a good whoopin’” crowd.

For zinc:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14687872 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8682903

For iron:

For nutrition and behavior in general:
(This discusses the effects of dietary supplements on violent behavior, not specifically ADHD.)

Note that I am not claiming that there is evidence that poor nutrition causes ADHD, just that poor nutrition may cause ADHD-like symptoms. There are also a wide variety of other factors that can mimic ADHD without actually being ADHD. For example, if a child is mildly hearing impaired, it may appear that they aren’t paying attention very well, but correcting the hearing can solve the problem.

Our son has been diagnosed with ADHD, but he has a variety of other health problems too, including hearing impairment, failure-to-thrive/poor appetite, hypothyroidism, low muscle tone, and low growth hormones. He has taken zinc supplements in the past to improve his appetite, and that led me to see if any research had been done on links between ADHD-behavior and low zinc levels. (The zinc supplements helped his appetite temporarily, but did not help the behavior.) His ADHD is also hyperactive-impulsive type, with no real attention deficit–we have to remind his teachers that if he doesn’t seem to be paying attention, his hearing aid batteries are probably dead. He also has a lot of Asperger’s-like traits, including hyperfocusing on specific topics, little understanding of how to interact with others, and an intense fascination with anything that spins.

I do not dispute the reality of ADHD, but I also don’t see the harm in looking at other possible explanations for the behavior even while treating the ADHD symptoms as ADHD.

Well, we do this in health care, quite a bit, as does Joe Layman at home–you take acetominophen for a headache, right? You don’t know the cause of the HA, but you treat the symptom. If your symptoms don’t improve or you find the cause (a cat and your allergic or whatever)–you can change the treatment.

docs deal in signs and symptoms–signs are objective, symptoms are subjective. ADD/ODD/Asperger’s, from what I know of them (which is not much) tend to have clusters of symptoms that lead health professionals to group them as syndromes.

I am sure that this field is growing astronomically, given the rise in autism diagnoses in recent years. The hard data will come–but why have people suffer in the meantime?

ITA that the treatment should be pt focused, not a convienence for the family (I doubt that many medicate for convenience).

Sorry I had to run before I finished my post. But a wag I had was people study those few who made real contrubutions and see patterns, which also corrospond to patterns a few other people who are really having a tough time. It is useful to have a name for this pattern (such as ADD), though one can’t directly ‘find’ ADD.