What did Leon Eisenberg say before he died about ADHD?

On September 15, 2009 Leon Eisenberg, American psychiatrist of great fame and prestige, died due to cancer that he suffered.

Some time later, specifically in 2012, the newspaper Der Spiegel would unleash 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 the Attention Deficit Hyperactivity Disorder or ADHD it was a made-up disease.

Before focusing attention on the controversy caused by such an alleged statement, let's remember what we are talking about when referring to ADHD.

Attention Deficit Hyperactivity Disorder: what are we talking about?

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

ADHD symptoms

For the diagnosis of ADHD, it has been established that at least six or more symptoms of inattention must be present (neglect of details, difficulties maintaining attention). attention, busy mind that makes you not listen, not completing or following through on tasks or instructions due to distraction, organization 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 fiddling, get up in circumstances where you should remain seated, motor restlessness, excessive talking, difficulty taking turns, interruption of the activities of others, anticipation of the other's response in a conversation reaching the end of others' sentences, inability to play calmly, running around in situations inappropriate).

Some of these symptoms may seem normal at certain ages, but for diagnosis ADHD requires that they be maintained for six months in a degree that does not correspond to the level of development of the subject, taking into account the subject's age and intellectual level. In other words, the diagnosis takes or should take into account that the symptoms occur abnormally or exaggeratedly. It is also taken into account that the symptoms do not occur in a single environment or situation, but that they occur in a generalized way in at least two different environments (ruling out that they only occurred in the school) and producing a clear deterioration of the activities of the individual.

Although for its diagnosis it is necessary that there have been any symptoms before the age of seven, attention deficit hyperactivity disorder can be diagnosed at any age, including in the adult stage.

In this last aspect, it must be taken into account that although some aspects of ADHD seem to be corrected with age (as the frontal cerebral maturation, which in this disorder is usually slowed down), especially in the case of symptoms of hyperactivity, in many untreated cases some symptoms persist, such as reduced attention span and a certain sense of inner restlessness.

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

Numerous publications seem to indicate that the one that mr. Eisenberg was the discoverer of ADHD. This consideration is not entirely correct: although Dr. Eisenberg was highly 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 was called by different shapes. In fact, the "discoverer of ADHD" himself once indicated that the disorder was already well known before he worked on it: there are references to children with the same symptoms since 1902 by George Still (who would classify them as children with moral control deficit) and even descriptions prior to this.

Despite this, Mr. Eisenberg did play a very important role in the consideration of this disorder: he was a pioneer in giving due importance to genetic factors in the etiology of this disorder (before he and other authors advanced in their research from a perspective more biological and neuroanatomical, some of the etiological explanations of the disorder centered on the absence of a correct socio-emotional bond with the parents, especially with the mother, with which the parents were partly blamed for the disorder of their son), as well as introducing ADHD in the reference manual of psychiatry and psychology american, the Diagnostic and Statistical Manual of Mental Disorders or DSM. It is this last fact that has probably caused Leon Eisenberg to be sometimes called the discoverer of ADHD.

The Discord Article

That being said, let's once again focus our attention on the origin topic of this article: the supposed confession of its non-existence. In an article that appeared in the newspaper Der Spiegel the interviewee's words seem clear, but they appear out of context, making it easy to misrepresent the meaning they had in their initial context. In fact, part of the problem is based on a misinterpretation of the meaning of the words in their English-German translation. The interview in question also focused on examining the increase in diagnoses of mental disorders in recent times.

With a more contextualized review of the situation of the interview, it is possible to observe that the criticism of the so-called discoverer of ADHD was focused on the spectacular increase in the number of alleged new cases of ADHD. problem.

So, the well-known psychiatrist referred to the overdiagnosis of this disorder, often treating pharmacologically 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 location or lifestyle, or others losses personal (in which case ADHD should not be discussed unless it is a problem unrelated to the life events in question).

Another critical point is the excessive tendency to prescribe medication, given that despite the fact that it can be a great aid to those who suffer from it, may be detrimental if administered to individuals without this disorder. In addition, we must take into account the fact that they are usually minors, so special care must be taken when administering psychotropic drugs. In addition, in the same interview he indicated that even if there is evidence of a certain genetic predisposition to this disorder, this was overvalued, requiring more research on the causes psychosocial.

A critique of overdiagnosis

In conclusion, it can be considered that the article that indicated that doctor Eisenberg had denied the existence of ADHD is the product of a misinterpretation of his words, the psychiatrist not having indicated that the disorder does not exist, but that it is diagnosed with excessive haste, making the diagnosis in cases that do not suffer from it.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Massón, Barcelona.

• Barkley, R. (2006). Attention-Deficit Hyperactivity Disorder, Third Edition: A Handbook for Diagnosis and Treatment, Guildford Publications. New York.

• Eisenberg, L. (2007). Commentary with a Historical Perspective by a Child Psychiatrist: When “ADHD” Was the “Brain-Damaged Child”. Journal of Child and Adolescent Psychopharmacology, 17(3): 279-283.

• Grolle, J. & Samiha S. (2012). "'What About Tutoring Instead of Pills?" Der Spiegel. 02.10.2012

• Miranda, A., Jarque, S., Soriano, M. (1999) Attention deficit hyperactivity disorder: current controversies about its definition, epidemiology, etiological bases and approaches to intervention. REV NEUROL 1999; 28 (Suppl 2): ​​S 182-8.

• Vonblech, J. (2012). "Schwermut ohne Scham." Der Spiegel. 06.02.2012.