The myth of ADHD: what did Leon Eisenberg really say before he died?

May 1, 2024

On September 15, 2009 Leon Eisenberg, an American psychiatrist of great fame and prestige, died due to his cancer.

Later, specifically in the year 2012, the newspaper Der Spiegel would unleash a great controversy to publish 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 focusing attention on the controversy raised by such a supposed statement, remember what we are talking about when referring to ADHD.

Attention Deficit and Hyperactivity Disorder: what are we talking about?

It is understood by ADHD a set of diverse symptoms grouped around inattention, hyperactivity and impulsivity , presenting itself in a stable way during a period of at least six months.

The symptoms of ADHD

For the diagnosis of ADHD, it has been established that there must be at least six or more symptoms of inattention (carelessness of details, difficulties in maintaining attention, busy mind that does not listen, no completion or follow-up of tasks or instructions for distraction, difficulties of organization, loss of elements, avoidance of tasks sustained over time, easy distraction, forgetting of daily activities) and / or six symptoms of hyperactivity and impulsivity (constant play, getting up in circumstances where you should remain seated, motor restlessness, speech excessive, difficulty waiting for the shift, interruption of the activities of others, anticipation of the response of the other in a conversation, ending the sentences of others, inability to play quietly, running in inappropriate situations).

Some of these symptoms may seem normal at certain ages, but for the diagnosis of ADHD requires that they be maintained for six months to a degree that does not correspond to the level of development of the subject, taking into account the age and intellectual level of the subject . That is to say, in the diagnosis it is or should be taken into account that the symptoms occur abnormally or exaggeratedly. It is also taken into account that the symptomatology does not occur in a single environment or situation, but rather occurs in a generalized way in at least two different environments (discarding therefore that 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 some symptoms before the age of seven, the attention deficit hyperactivity disorder can be diagnosed at any age, including in the adult stage.

In this last aspect we must bear in mind that while some aspects of ADHD seem to be corrected with age (as cerebral maturation of the frontal is occurring, 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 internal restlessness.

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

Numerous publications seem to indicate that the Mr. Eisenberg was the discoverer of ADHD . This consideration is not entirely correct: although Dr. Eisenberg had great relevance 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 denominated as different. shapes. In fact, the "discoverer of ADHD" himself indicated on occasion 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 a deficit of moral control) and even descriptions prior to this one.

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

The article of discord

That said, let's focus again on the origin of this article: the alleged confession of its nonexistence. In the article appeared 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 also focused on examining the increase in diagnoses of mental disorders in recent times.

With a more contextualized review of the interview situation, 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 supposed new cases of the problem.

A) Yes, the well-known psychiatrist made reference to the overdiagnosis of this disorder , in many cases being pharmacologically cases in which the disorder does not exist and in which of having symptoms these can be due to psychosocial factors, such as the divorce of the parents, changes of locality or lifestyles or other personal losses (in which case ADHD should not be discussed unless it was a problem unrelated to the life events in question).

Another critical point is the excessive tendency to prescribe medication, since although it can be a great help for those who suffer it, it can be a disadvantage if it is administered in individuals without this disorder. In addition, it is necessary to take into account the fact that it is usually about minors, with which it is necessary to take special care when administering psychotropic drugs. In addition, in the same interview indicated that even if there is evidence of a certain genetic predisposition to this disorder, it was overvalued, requiring more research on psychosocial causes.

A critique of overdiagnosis

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

Bibliographic 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: 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) Hyperactivity disorder with attention deficit: current controversies about its definition, epidemiology, etiological bases and approaches to intervention. REV NEUROL 1999; 28 (Suppl 2): S 182-8.