A good example of claims inflation in relation to ADHD drugging and science
Background – what is ADHD?
This is an article in the Guardian by Alexandra Topping who is described as a “Senior News Reporter”. The headline on the piece is: “Benefits of ADHD medication outweigh health risks, study finds” . This caught my eye, because I know that this is propaganda. I have done a lot of work [1] on this previously, thoroughly reviewing some of the defining ADHD studies and the complete NICE Guideline on ADHD drugging. There is a narrative, as we see in this headline, that “science” supports “ADHD medication” – that this has all been verified by “studies”. This is the narrative which the ADHD industry promotes. What I found, when I looked into it, was that the problem often starts with the studies. Many studies start with a preconceived idea, for example to justify ADHD drugging over behavioural approaches, and they then, visibly, massage their results to produce such a finding. Results which emerge in the study which do not support the desired conclusion are minimised or silently discarded. Or, a new statistical analysis manages to rescue the desired result in one section of the data. Small statistical findings which support the desired results are amplified. But; even before all the games with statistics the studies, especially those which concern the efficacy of ADHD “medication” start off by the entirely unscrupulous ruse of defining undesirable behaviours in children as “medical symptoms”. “Benefits” are then measured by a “reduction in symptoms”, which turns out to mean, that little Jimmy is less disruptive in class. That little Jimmy may be being less disruptive in class because he is knocked out by the exhausting effect of being kept continually over-stimulated by stimulant drugs, (at least some of which are simply repurposed slimming aids which probably explains the stunted growth), is not considered.
What is ADHD? ADHD is a construct of psychiatry. It is associated with a list of behavioural markers. If a child matches the behavioural markers, (in the view of parents, the teachers and a psychiatrist), they can be labelled ADHD. There is no biological test. ADHD is not an illness. Having thus produced a category of children, (increasingly adults), “with ADHD” the field is then open to researchers to find statistical associations between this cohort and some factor of interest. For example, studies can find a statistically significant correlation between this cohort and a certain kind of genetic damage. Academics with access to MRI scanners have produced no end of studies which show statistical links between certain patterns of brain activity in ADHD children and non ADHD children. Some of these studies even manage to exclude drugged children from the ADHD cohort to remove the possibility that the unusual brain patterns are the result of drugging. All of these studies are reported as if they were telling us, the public, something about “ADHD” “Scientists have discovered that ADHD children think differently”, for example. But, the studies do not do this. They show statistical correlations between the label and the factor of interest. This does establish that the label is not completely arbitrary, but not much else.
They key point is none of these studies provide a medical explanation for ADHD drugging. The few studies which do attempt to explain how stimulant drugs are efficacious “for ADHD” produce contrary results. The manufacturer of the leading stimulant is very cautious about the efficacious route of their product: “There is neither specific evidence which clearly establishes the mechanism whereby Ritalin produces its mental and behavioural effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system“. [2] That is; the link between the establishing of a statistical correlation between ADHD and some kind of abnormality is one thing. But the leap from there to the supposed “benefits” of ADHD drugging usually happens by magic. In general it seems that promoters of ADHD drugging feel it is enough to establish some kind of abnormality. And then the drugs will sell themselves.
There is one other statistical correlation we should mention. Multiple studies have found statistical correlations between having an ADHD diagnosis and being young for the class. [3] Teachers and parents are simply mistaking the fact that the younger children in a class find it harder to keep up, with them having some kind of (pseudo-)medical condition! The studies I refer to are all related to testing the hypothesis against a group of school students. I was not, however, at all surprised to learn that at a national level in the UK, there is also a correlation between SEND and age in class. [4] “Misdiagnosing” lack of attention as a medical or SEND problem when it is simply normal variance within a class is widespread. (The full paper as relates to SEND and age may make a more complex argument than this; nonetheless the same overall trend is noticed).
In summary, ADHD is a psychiatric label which correlates to statistical markers in various ways. Some correlations show “mis-diagnosis”, (on the assumption that one would expect a medical diagnosis not to be linked to birth month). Others show a correlation to genetic abnormalities or unusual brain patterns. Note that, not all ‘ADHD children’ will have such genetic abnormalities or show unusual brain patterns. These are group-level statistical correlations. The key point though, really, about the ADHD hoax is that there is no medical explanation for how the drugs work. In essence, most, (but not all), ADHD drugs are stimulants. What is presented as “treatment for a condition” is, in fact, nothing more than a state-authorised programme for improving the concentration of children who concentrate less well than their peers, for whatever reason, with stimulants. There is no mystery to this. Stimulants improve concentration; in any child. (One ADHD researcher admits this in what was certainly an off-message moment. [5]) Long-term use of stimulants is very harmful, which is why the government, in general, cautions young people against taking them. That the harm is generally evident as a result of long-term usage probably explains why when the harms are even considered at all in ADHD drugging studies, the focus is usually on the short-term. ADHD is a concoction of psychiatry; they need a “condition” in order to be able to prescribe the drugs. You can’t just say “some children are a bit fidgety and this disrupts the class, let’s give them stimulants”. The public wouldn’t stand for that, dystopian, Brave New World, idea. But, with a bit of effort you can spin a story about a “condition” with “symptoms” which “benefit” from “medication”.
Claims inflation in the media
All this provides the background to the Guardian article I wish to comment on. It is an absolutely classic example of claims inflation. Claims inflation works like this. A group of academics produce a paper. It might be a meta study, a study using an MRI scanner, or genetic analysis, or some other kind of study. The study is published in a peer reviewed journal. It has to meet certain criteria. You cannot simply produce fake data, though, you are certainly allowed to be highly selective about what you test for and what statistical manipulations you perform. Usage of semantic devices like recasting inconvenient behaviours as “symptoms” do not appear to be controlled for in “scientific” journals. Usage of subjective reporting is allowed so long as the statistics are sound. So, if a statistically significant count of parents agree that Jimmy’s “symptoms have improved” that can be reported as a “finding”. At any event, that comment aside, studies do have to be robust enough to survive peer review. Some studies are quite valid and interesting. For example, one important genetic study found a correlation between a particular type of genetic damage and an ADHD diagnosis. The same specific genetic damage is also implicated in autism. What happens next is what is interesting. It seems, somewhat anecdotally, that there is sometimes one researcher, out of several on the paper, who takes the initiative and gives statements to the press making claims which are not established by the study in question. These claims are highly supportive of the official psychiatric-pharmaceutical endorsed narrative on ADHD drugging. In the case of the genetic paper which I mention above, interesting and valid in its own right, one researcher went ahead and gave multiple statements to the press which claimed that the study had established that “Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to the brains of other children.”. In reality, her study had established no such thing. The majority of the ADHD children did not have the genetic abnormality in question. (And, there were other problems with the study, such as a cross-over with Learning Difficulties). But, following such fake claims the media, (through scientific illiteracy or active collusion, I don’t know), produced headlines such as: “Bad behaviour down to genes, not poor parenting, says study”. (This one was in the Independent). In this case other researchers on the same study gave more cautious and, in general, accurate statements about the study. For example; “Children with ADHD have a significantly higher rate of missing or duplicated DNA segments compared to other children and we have seen a clear genetic link between these segments and other brain disorders.” [6] But, in general, it was the exaggerated claims which were reproduced in the media. (However; in this case the BBC provided a notable exception, saying, “Because those bold claims do not seem to be borne out by the actual research paper.“).
Claims inflation in the Guardian
The claim in the Guardian is: “Benefits of ADHD medication outweigh health risks, study finds“. The study itself is here. I am basing my comments on the abstract of the study. (It is a small frustration of mine that academic papers are priced so as to make them affordable for people who have departmental budgets to pay for them, but not for citizens simply taking an interest). In this case the key points are available in the abstract. The study was a meta study, (a review of other studies), which “aimed to compare the effects of pharmacological treatments for ADHD on haemodynamic values [blood flow] and electrocardiogram (ECG) parameters in children, adolescents, and adults.” That is it was focussed on one specific area; the effect on blood flow and cardiovascular variables as a result of taking “amphetamines, atomoxetine, bupropion, clonidine, guanfacine, lisdexamfetamine, methylphenidate, modafinil, or viloxazine”. Based on the abstract the study looks like a perfectly valid piece of science. The metrics relate to actual physical measurable values, not “symptoms”. I don’t see any evidence of statistical manipulation. Though it does, or course, appear to accept that ‘ADHD’ is a condition.
The finding of the study was that most of these drugs led to small increases in haemodynamic values [blood flow to a layman I think] but guanfacine was associated with a small decrease. Guanfacine seems to be a drug primarily used for treating high blood-pressure which has been repurposed for treating ADHD. [7] Effects on pulse were also noted. (The general public might be surprised to learn that the full spectrum of ADHD drugs includes an eclectic assortment of repurposed slimming treatments, repurposed anti-depressants and, even, here, a repurposed blood pressure drug). I am more than willing to believe the statement by Professor Samuele Cortese made to the press about his study that the study “… found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications“. This same quote is found in the Guardian article and also in an online science journal called Medical Express. [8] It would seem like these remarks were likely made in a statement released to the media.
The opinions and statements to the media in relation to this study
When Professor Samuele Cortese says in the press release or to the Guardian, “Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring for people taking ADHD medications.” this is his professional opinion and not a finding of his study. Some of his claims here are contentious. The defining MTA Multi-Modal study found an improvement in reading but despite testing for them not in maths or spelling. This in itself is an example of how the ADHD narrative works; any evidence which supports the narrative is amplified. Any counter or less helpful evidence is silently dropped. (Peter Breggin, a psychiatrist and well-known ADHD critic says that even the claim for improvements in reading in the MTA study are contestable on statistical grounds [10]). But; the main point here is that even if giving children amphetamines slightly increases their score in a reading test is that really something we want to be doing? Does that really help the children? An advisory for Ritalin™ states: “Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems” [11]. In fact a wealth of material exists which links amphetamines and stimulants to heart problems so Professor Samuele Cortese seems to have a rather rosy opinion about stimulants. Possibly, “cardiovascular diseases” does not include “sudden death.. heart problems”, and these reports may arise from adverse reporting rather than studies, but even so the overall picture does not look quite as rosy as Professor Cortese seems to suggest. (This is how the NICE Guideline on ADHD sums up the risk from methylphenidate: “The long-term studies of methylphenidate indicate an increased risk of side effects, increase in systolic blood pressure and heart rate problems. Given the lack of background rates, the association between the use of methylphenidate and sudden death is not clear“. [8] If true that other cardiovascular diseases are not caused that is good; but then it is probably true that methylphenidate doesn’t cause leprosy). But; the main point is that Professor Samuele Cortese’s claims about “risk-benefit ratio is reassuring“ are not supported by the study. Professor Samuele Cortese is of course completely free to cite his reading of the overall literature and the opinion he has formed based on this. But; this view is in no way supported by his study, which simply points to a relatively small alterations in metrics associated with blood flow and pulse.
Interestingly another researcher on the study, Dr. Luis Farhat, gives a completely different emphasis to the study, and one much more closely tied to the actual study, (not his general opinion): “Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants. This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system”. [9] This seems to emphasise that the study did find some risk and as a result recommends more caution.
Another researcher on the study, Professor Alexis Revet, emphasises the problem with the short-term nature of most of the studies they reviewed: “Our findings, based on randomized controlled trials that tend to be of short duration due to ethical issues, should be complemented by results from real-world, longer-term studies.” [9]
Professor Cortese is reported in Medical Express as saying: “While our findings are informative at the group level, that is, on average, we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations”. This is a much less “reassuring” picture than the one which emerges in the Guardian. Though the Guardian does say: “The researchers advised people with existing heart conditions to discuss the side effects of ADHD medications with a specialist cardiologist before starting treatment.”.
The Guardian headline
Let’s return to the Guardian headline: “Benefits of ADHD medication outweigh health risks, study finds”. Did the study find this? No, not even remotely. (This is like taking a blood test, checking for one or two conditions, and on the basis of that saying the patient is in perfect health). It didn’t discuss “benefits”, let alone enter into a discussion as to what a “benefit” is when the condition in question is a “behavioural disorder” and not a medical condition. Did it consider a range of possible harms? No. It focussed on 2 very specific metrics; do with blood flow and pulse. Did it consider even these in the longer-term? Hardly at all, a point made in the formal study findings itself and emphasised to the media by one of the researchers. Were the results “reassuring” or do they provide a basis to call for more clinical monitoring, which, obviously, implies risk? It depends which of the researchers on the paper you ask.
The Guardian has taken a specific study which has a place within the overall literature on ADHD (almost all, by definition, produced by academics who do not question the basis of the “diagnostic category”) about the effect of some ADHD drugs on blood blood flow and pulse. Findings that there are relatively small effects lead to a call for more research from one of the researchers, and a call for more clinical monitoring from another. This is a small, precise, meta study focussed on one single aspect of the whole ADHD “medication” story. And yet, we end up with the entirely fictitious: “Benefits of ADHD medication outweigh health risks, study finds”. This is a wonderful example of claims inflation. Somehow we get from a valid study to a media headline which is clearly promoting the ADHD drugging narrative but which is in no way justified by the study.
Academic work is being misused to generate drugging propaganda. Where, in the chain, the inflation happens, may vary from case to case. In the case of the genome study, mentioned above, the key link in the chain was one researcher who made claims to the media which went far beyond anything which was established by her study. In this case Professor Samuele Cortese seems to have made some quite rosy statements adding the findings of the study to his existing opinions. It may not be his fault, however, if the media reporting has not made it clear where the study findings ended and where Professor Samuele Cortese’s personal opinions, started. In this case at least it looks like the inflation is on the side of the Guardian.
Let’s give the floor to the ADHD drugging narrative
The author of the Guardian article concludes with a lengthy quote from Dr Tony Lloyd who was formerly involved in an ADHD Charity:
“Sadly ignorance about ADHD medications persists – a throwback to the 80s and 90s when ADHD medications were mistakenly viewed as a morality pill that made naughty, fidgety disruptive children behave – which of course it is not,” he said.
“It is simply a cognitive enhancer that improves information processing, inhibits distractions, improves focus, planning and prioritising, self monitoring and reduces impulsivity of thought and action.”
This is not scientific. As the study itself reveals; there are a wide range of ADHD drugs and you cannot talk about them all as if they all have the same effect. Nor does the fact that stimulants “improve focus”, (as they do for all people, but are best taken in the very short-term), somehow invalidate the criticism that ADHD drugging is primarily about behavioural control.
Whether this claims inflation is deliberate and manipulative or whether it just sort of happens, (Professor Cortese simply wants to “reassure” people; the Guardian journalist has a pro ADHD drugging contact in her address book who she automatically contacts when an ADHD story comes up; the editor is looking for a sensational headline), I don’t exactly know.
Will the Guardian correct their false headline?
I sent an email to the “Readers’ Editor” at the Guardian about this article. I got an auto acknowledgement back saying that they read all emails. I made the point that the headline of their article cannot be justified based on the study. I wrote that “In no world known to science does this mean that the study found ‘Benefits of ADHD medication outweigh health risks, study finds’”, and explained why. The Guardian can disagree with much of what I write above. For example; in the world of mainstream journalism quoting the kind of nonsense uttered by ADHD proponent Dr Tony Lloyd is acceptable journalism. (He is a authoritative source, and as in mediaeval times, authority counts for far more than reason when it comes to knowledge). Calling ADHD drugs “medication” is also acceptable in mainstream journalism, because that is what the powers-that-be do, and mainstream journalism does not adopt a critical stance towards power. But – that a meta study focussed on the effects of two blood metrics, pressure and pulse, from ADHD “medication” and nothing else establishes that “Benefits of ADHD medication outweigh health risks” is insane. It is taking one small part of a picture and based on that making a claim about the whole. It fails any test of reason even without expressing any view at all about the whole ADHD story. I was interested to see if the Guardian would correct their headline. They didn’t, (at least at the time of writing). This establishes that this was not simply a mistake by an editor who misunderstood the study. It establishes that the Guardian is quite happy to brazenly publish fake propaganda and, essentially, untruths, in support of the ADHD drugging narrative. That is an interesting finding. It shows they are more craven towards big pharma and psychiatry and have even less integrity, than I would have expected.
Notes
- ADHD – complete investigation. https://thenewobserver.co.uk/wp-content/uploads/2015/06/full1.pdf
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/010187s077lbl.pdf
- ibid. 1. Section 1) vi)
- https://sticerd.lse.ac.uk/dps/case/cp/casepaper223.pdf “Summer-born children, particularly boys, are much more likely to be attributed both ‘higher’ and ‘lower’-level SEND by the end of their primary school career, and there are also stark inequalities in the types of SEND ascribed to boys and girls born across the year.“.
- In the 1970s, researchers showed that a positive response to stimulants is not limited to children with ADHD: ‘normal’ children show improvements in attention and focus as well. Therefore, to some degree, the medications enhance performance rather than treating the specific psychopathology . Dr Ilina Singh. Beyond polemics: science and ethics of ADHD. ature. Neuroscience. Volume 9. December 2008. p 958
- The study in question is: Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis” (Nigel M Williams et al. 2010) was published in the Lancet in September 2010. The exaggerated claims making was by Professor Thapar. The more accurate accounts of the study were given by Professor Nigel Williams.
- https://onlinelibrary.wiley.com/doi/10.1111/j.1527-3458.2007.00026.x
- NICE. The NICE Guideline on Diagnosis and Management of ADHD in children, young people and adults. The British Psychological Society and The Royal College of Psychiatrists. 2009.
- https://medicalxpress.com/news/2025-04-effects-adhd-medications-heart.html
- Dr Peter Breggin. The NIMH multimodal study of treatment for attention-deficit/hyperactivity disorder: A critical analysis. International Journal of Risk & Safety in Medicine. Issue 13. 2000.
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/010187s077lbl.pdf