Is ADHD a fictitious disease?

Question

I found this meme:

Inventor of ADHD's Deathbed Confession: "ADHD is a fictitious disease"

US American psychiatrist Leon Eisenberg, born in 1922 as the son of Russian Jewish immigrants, who was the "scientific father of ADHD" said at the age of 87 in his last interview: "ADHD is a prime example of a fictitious disease."

I tried to search but couldn't find anything clear enough. Honestly I didn't even find anything to confirm whether the guy is real or not, let alone mentioning the alleged confession.

The closest thing I was able to find is an Attitude Magazine article, article, Is ADHD a disease?:

The question, then, should not be whether a person having ADHD traits has a disease, but whether the adult or child will be better off — not the next day in class, but in the long run — undergoing treatment that reduces the normalcy gap.

Is ADHD fictitious?

Answer 1

The original source of the quote is here: https://magazin.spiegel.de/EpubDelivery/spiegel/pdf/83865282

Ein großer, hagerer Mann mit Brille und Hosenträgern öffnete 2009 die Tür zu seiner Wohnung am Harvard Square, lud an den Küchentisch und schenkte Kaffee aus. Niemals hätte er gedacht, erzählte er, dass seine Erfindung einmal derart populär würde. „ADHS ist ein Paradebeispiel für eine fabrizierte Erkrankung“, sagte Eisenberg. „Die genetische Veranlagung für ADHS wird vollkommen überschätzt.“

Which google translate resolves as:

A tall, thin man with glasses and suspenders opened the door to his Harvard Square apartment in 2009, invited people to the kitchen table and poured coffee. He said he never would have thought that his invention would one day become so popular. "ADHD is a prime example of a manufactured disorder," Eisenberg said. "The genetic predisposition for ADHD is completely overestimated."

This answer is verbatim the snopes article on the topic: https://www.snopes.com/fact-check/work-of-fiction/

Rating: Mostly True

What's True A German-to-English translation of an interview showed that Eisenberg said something similar to "ADHD is a prime example of a fictitious disease."

What's False Eisenberg was referring to the influence of social and environmental risk factors for the condition.

Dr. Leon Eisenberg, who passed away at the age of 87 in 2009, was a prominent figure in the field of child psychiatry who during the 1950s and 60s conducted medical studies of children with developmental problems, including some of the first rigorous studies of autism and attention deficit disorder. As described by the British Medical Journal (BMJ), Dr. Eisenberg "transformed child psychiatry by advocating research into developmental problems":

Early in his medical career, in the mid-1950s, Leon Eisenberg became fascinated with the childhood mind. Wanting to know more, he broke free from the shackles of the Freudian psychoanalytic dogma that dominated child psychiatry at the time to conduct groundbreaking biologically based research of childhood developmental problems. This research included the first randomised clinical drug trials in child psychiatry.

"I think what Leon brought to the field was a different way of thinking — thinking out of the box," said David DeMaso, chairman of psychiatry at Boston Children’s Hospital and professor of psychiatry and pediatrics at Harvard Medical School. "He was thinking in terms of biology, of evidence based treatment, way before anybody else. His was a bio-psycho-social model at a time when psychoanalytical thinking was the norm."

Eisenberg’s direct involvement as a child psychiatry researcher was over by 1967, when he moved to Harvard Medical School as chief of psychiatry at Massachusetts General Hospital. But in a dozen years he had helped transform the discipline.

Although describing Dr. Eisenberg as the "inventor" or "father" of attention deficit disorder (ADD) and/or attention deficit-hyperactivity disorder (ADHD) might be challenged by some as a bit of an exaggeration, he unquestionably contributed a great deal to the body of knowledge on which modern diagnoses and treatment of those disorders is based. Given Dr. Eisenberg's recognized authority and expertise in this field, therefore, those who feel that ADD and ADHD are misused and over-employed diagnoses which serve to "excuse bullying and recklessness" and "offer a sense of alleviation of personal responsibility among those diagnosed" would indeed find validation if Dr. Eisenberg had proclaimed "ADHD is a fictitious disease":

Example: [Collected via e-mail, May 2013]

I’ve been seeing this story making the rounds about how the alleged “inventor” of ADHD (a Dr. Eisenberg) had a sort of deathbed confession, and, in an interview with Der Spiegel 7 months before he died at 87, said, “ADHD is a prime example of a fictitious disease.”

Leon Eisenberg, the father of ADHD, is quoted as saying in Der Spiegel that “ADHD is a fictitious disease” (shortly before his death).

The claim that Dr. Eisenberg asserted "ADHD is a fictitious disease" is reproduced on countless web sites as something he said "seven months before his death in his last interview," which would place the date of his utterance around February 2009. When documentation for the putative quote is provided, it references an article (often described as a "cover story") published in the German weekly Der Spiegel on 2 February 2012.

We found that the German-language version of Der Spiegel ran an article in 2012 that skeptically examined the large increase in diagnoses of mental disorders in recent years and quoted Dr. Eisenberg on that subject. A software-based translation of that article from German to English does describe Dr. Eisenberg as the "father of ADHD" and report that during his "last interview" he said something similar to "ADHD is a prime example of a fictitious disease." However, when one allows for the vagaries of translation from German to English and reads the statement in context, it's clear that Dr. Eisenberg wasn't asserting that ADHD isn't a real disorder, but rather that he thought the influence of genetic predispositions for ADHD (rather than social/environmental risk factors) were vastly overestimated:

One out of every ten 10-year-old boys already takes an ADHD drug daily. But the scientific father of ADHD has followed the explosion of prescriptions with growing horror. Leon Eisenberg took over the management of psychiatry at the prestigious Massachusetts General Hospital in Boston and became one of the most famous psychiatrists in the world. In his last interview, seven months before his death from prostate cancer at the age of 87, he distanced himself from his youthful indiscretion.

A tall, thin man with glasses and suspenders opened the door to his apartment in Harvard Square in 2009, invited me to the kitchen table, and poured coffee. He said that he never would have thought his discovery would someday become so popular. "ADHD is a prime example of a fabricated disorder," Eisenberg said. "The genetic predisposition to ADHD is completely overrated."

Instead, child psychiatrists should more thoroughly determine the psychosocial reasons that can lead to behavioral problems, Eisenberg said. Are there fights with parents, are there are problems in the family? Such questions are important, but they take a lot of time, Eisenberg said, adding with a sigh: "Prescribe a pill for it very quickly."

On a related note, an August 2012 Der Spiegel English-language interview with (now retired) Harvard psychologist Dr. Jerome Kagan quoted Dr. Kagan as being critical of "fuzzy diagnostic practices" and the over-prescription of drugs such as Ritalin for behavioral problems in children, and as referring to ADHD as "an invention":

SPIEGEL: In the 1960s, mental disorders were virtually unknown among children. Today, official sources claim that one child in eight in the United States is mentally ill.

Kagan: That's true, but it is primarily due to fuzzy diagnostic practices. Let's go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). That's why the numbers have soared.

SPIEGEL: Experts speak of 5.4 million American children who display the symptoms typical of ADHD. Are you saying that this mental disorder is just an invention?

Kagan: That's correct; it is an invention. Every child who's not doing well in school is sent to see a pediatrician, and the pediatrician says: "It's ADHD; here's Ritalin." In fact, 90 percent of these 5.4 million kids don't have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they'll make the corresponding diagnosis.

Answer 2

For what's worth it, this was hardly a "deathbed confession" (he died in 2009), meaning something he didn't say before [in some way]. A cursory search finds a short paper of his from 2007, in which, in summary he says that:

• A 1970 study on some island [Isle of Wight] found that the rate of hyperkinetic syndrome was 1 in a 1000.

• Recent US CDC data puts the ADHD diagnosis somewhere in between 5 and 8 percent, with large variations per state. So much higher than in the UK island study.

• About half of the US children so diagnosed get medicated. Said medication is a huge boon for the US pharma, according to Eisenberg. It also hugely biases published research results, when they sponsor them. (For the latter claim, he cites several papers.)

I'll quote you his summary:

ADHD has morphed from a relatively uncommon condition 40 years ago to one whose current prevalence is estimated to be just under 8% of U.S. children 4–17 years of age. Correspondingly, the prescription of stimulant drugs has gone up enormously. The reasons are not self-evident. Is treatment putting misdiagnosed children at risk? Has there been a real change in prevalence? And if so, why? Or are children who were previously missed now coming into care for the first time? These are important questions and warrant systematic investigation. It is time for the NIMH and the FDA to convene senior investigators, clinicians, and epidemiologists to plan large-scale systematic research on matters of serious consequence for child health in America.

So if this is what he meant by "fabricated" later on, it's not exactly a novel claim from him.

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BTW, if you ask the DSM-III authors (published 1980), the DSM-II criteria (which Eisenberg claims he was instrumental in establishing) were vague to point of being very, very interpretable, e.g.

A [1971] landmark study proved that British and US psychiatrists came to radically different diagnostic conclusions when viewing videotapes of the same patient. [...] Psychiatry's response was dramatic and effective. The DSM-III, published in 1980, featured detailed definitions of mental disorders that, when used properly, achieved reliabilities equivalent to much of medical diagnosis.

So, 1980s psychiatrists would have a rather easy answer for why a 1970s prevalence study had [vastly] different results...

Slightly more specific, the ADHD definition of DSM-III included a non-hyperactive variant, which alone probably gave way to an increase in the number so diagnosed:

Under the term "308.0 hyperkinetic reaction of childhood (or adolescence)," DSM-II describes a syndrome with such behavioral manifestations as "overactivity, restlessness, distractibility and short attention span" (APA, 1968). DSM-III renames this disorder "attention deficit disorder" (ADD) and divides it into two subtypes: "with hyperactivity" and "without hyperactivity," stating that "it is not known whether they are two forms of a single disorder or represent two distinct disorders." In addition to requirements of duration, age of onset, and absence of schizophrenia, affective disorders, or severe mental retardation, a diagnosis of ADD must be based on substantial signs of inattention and impulsivity (as well as hyperactivity for the subtype "with hyperactivity") (APA, 1980).

That [1983] retroactive US study also found a fair increase in ADD without hyperactivity diagnoses in a in a sample of 1530 patients. The DSM-II criteria being confusingly spread over 2-3 different categories, I'll include their full table here:

Given the retroactive nature of that study, some could not be diagnosed under DSM-III due to lack of relevant information on some DSM-III criteria, according to the paper's authors'.

Also, the point raised by Eisenberg was surely raised before, e.g. in this highly cited 2003 paper

For example, as pointed out by Taylor and Sandberg (5), data from studies in the late 1970s give a 20-fold greater prevalence of childhood hyperactivity in North America compared with England.

But as that paper later notes in great detail, numerous studies using DSM-III or DSM-IV criteria have shown rather more comparable figures across nations.

While the studies on US populations still report higher numbers, it's not on the orders of magnitude difference, generally speaking. Methodology of such studies matters a fair bit, e.g. at some extreme you can get orders of magnitude difference in the same population, using different assessment methodology:

it is interesting to note that in one of the Australian studies (citation 52), which reported the lowest prevalence rate (2.4%) when using combined teacher and parent assessments, the prevalence rates based on parent assessments alone (9.9%) and teacher assessments alone (8.8%) were similar to those reported in the US studies. Two studies additionally reported prevalence rates based on functional impairment and these rates were lower than those for symptoms alone - symptom prevalence, 7.5%; impairment prevalence, 6.8% (citation 19); symptom prevalence, 15.8%; impairment prevalence, 0.2% (citation 53).