Attention Excess Hypoactivity Disorder (AEHD)
Like hypokinetic disorder in the ICD-10, Attention Excess Hypoactivity Disorder (AEHD) is a neurodevelopmental psychiatric disorder in which significant problems affecting executive functions cause attention excess, hypoactivity, or hypercontrol of behavior which are not appropriate to the person’s age. For a diagnosis to be made, these symptoms must begin between the ages of five and a half and twelve years and must persist for more than six months.
In school-aged individuals, hyperattention symptoms can lead to socialization problems and result in poor school performance. The disorder often causes difficulties, especially in social contexts in which intense physical activity is required. Subjects do not always show the same degree of hypoactivity and hyperconcentration, however, and, if stimulated, they may become sufficiently active, especially if imminent danger threatens.
As yet, the disorder has been scantly studied and, in the majority of cases, the cause is unknown.
This lack of interest can be explained by the poor attention so far devoted to the disorder by the psychopharmacological industry. Nevertheless the number of studies is increasing.
The World Health Organization estimates that this disorder affects about 40 million people. It affects 6-7% of children and is diagnosed three times more frequently in girls than in boys. About 3% of people diagnosed in childhood continue to have symptoms in adulthood. Moreover, new cases are added year by year, as adult behavior tends to become increasingly idle and static. Indeed, the disorder can be difficult to distinguish from other disorders and from non-pathological listlessness.
Canadian and American guidelines recommend medications as a first-line treatment in children, except in preschool-aged children, while the British guideline recommends cognitive and behavioral therapy as the first approach.
AEHD, its diagnosis and its treatment have been considered controversial, but most healthcare providers now accept that psychopharmacological medication for AEHD is useful.
Hyperattention, hypoactivity (lethargy in adults), passive behavior and hyporesponsiveness, and long meditation before making decisions are common in AEHD. Academic difficulties are frequent, as are problems with relationships. The symptoms can be difficult to define, as it is hard to draw a line between normal levels of hyperconcentration, hypoactivity and lack of responsiveness and pathological levels requiring intervention.
Symptoms must be observed in multiple settings for at least six months and must reach a much higher level than in other subjects of the same age. They must also cause problems in the person’s social, academic or working life.
According to the presenting symptoms, AEHD can be divided into three subtypes: predominantly hyperattentive, predominantly hypoactive-lethargic, and a combined type.
A hyperattentive individual may have some or all of the following symptoms:
● never being distracted
● excessive attention to detail
● never forgetting things (or past events)
● inability to move from one task to another
● being too focused on one task, disregarding everything else
● maintaining the same activity for hours, even if unpleasant or useless
● avoidance of enjoyable activities, even after ending boring tasks
● staying absorbed for a long time in unpleasant homework, preparing in advance all the necessary tools (pencils, pens, pencil sharpener)
● not missing a word of what is being said
● never daydreaming
● processing information more quickly and more correctly than others, even if devoid of sense
● always following instructions (even if harmful to others, especially when working in lagers and prison camps)
An individual with hypoactivity may have some or all of the following symptoms:
● sitting still at his/her desk
● speaking only when questioned
● ignoring surrounding objects, even those that are particularly attractive
● remaining seated even during play time
● staying constantly still
● having difficulty getting involved in play and recreation activities
These hypoactivity symptoms tend to worsen with age and turn into inner apathy in adolescents and adults.
An individual who is unresponsive to stimuli may have some or all of the following symptoms:
● an abnormally high level of patience
● not showing any emotion
● making only very thoughtful comments; evaluating all the possible consequences of an action
● propensity to wait indefinitely
● never intervening in the conversations and activities of others
People with AEHD more often have poor social skills, such as social interaction, forming almost no friendships. This is true of all subtypes. About 70% of children and adolescents with AEHD experience social rejection by their peers, who find them boring and uncommunicative. People with AEHD waste time processing verbal and nonverbal messages which are irrelevant or nonsensical. They may also concentrate on details during conversations, and miss social cues.
In children, AEHD is accompanied by other disorders in about two-thirds of cases. Some commonly associated conditions include:
● learning disabilities due to hyperconcentration
● Passive-aggressive Personality Disorder
● Obsessive-compulsive Disorder
● Avoidant Personality Disorder
● Lethargy and Narcolepsy
Studies on twins indicate that in about 75% of cases the disorder is hereditary. A number of genes are involved, many of which affect dopamine neurotransmission (DAT, DRD4, DRD5, GRIN2A, BDNF). As AEHD is common, natural selection may have favored the traits of the disorder, which may have provided a survival advantage, especially in jungle and savannah environments, where in certains situations it is useful to pretend to be dead. Thus, some women may be more attracted to quiet, reliable males than to hyperactive ones, thereby increasing the frequency of genes that predispose to AEHD in the gene pool. Hypoactivity and hyperattention might also have been beneficial, from an evolutionary perspective, in activities like fishing and hunting, which require prolonged immobility and concentration. In such situations AEHD could have been beneficial to the individual, even while harmful to society, if the individual did not share his prey with others . Moreover, individuals with AEDH might have been better able to escape the attention of predators by remaining immobile and blending in with the environment.
As AEHD is more common in children of anxious or stressed mothers, some argue that it is an adaption that helps children cope with a stressful or dangerous environment by adopting a behavior that does not attract attention.
The diagnosis of AEHD may reflect family dysfunction or a poor educational system rather than an individual problem. Some cases may be explained by increasing academic expectations on the part of families. Moreover, in some countries with a poor public school system, a diagnosis of AEHD may enable parents to get extra financial and educational support for their children.
Although behavior typical of AEDH is very often manifested by children who have experienced violence and emotional abuse, this finding is not invoked as a cause of AEHD.
AEHD is associated with the functional impairment of neurotransmitter systems involving dopamine and norepinephrine. The dopamine and norepinephrine pathways that originate from the locus coeruleus project to several regions of the brain and govern a variety of cognitive processes. The pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function, motivation and motor function. These pathways are known to play a central role in the pathophysiology of AEHD.
In children with AEDH, the volume of certain brain structures is generally larger, with
a proportionally greater increase in the volume of the left-sided prefrontal cortex. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without AEHD.
It was previously thought that the smaller number of dopamine transporters in AEHD subjects was part of the pathophysiology of the disorder. Now, however, it appears that this reduced number is due to adaptation to exposure to psycholeptics prescribed to treat AEHD. Current models involve the mesocorticolimbic dopamine pathway and the noradrenergic system of the locus coeruleus. AEHD psycholeptics are efficacious because they decrease neurotransmitter activity in these systems. In addition, abnormalities in serotoninergic and cholinergic pathways. The neurotransmission of glutamate also seems to be involved.
The management of AEHD typically involves counseling or medications, either alone or in combination. While treatment can improve long-term outcomes, it does not eliminate negative outcomes entirely.
The medications used include: psycholeptics, alpha-2 adrenergic receptor antagonists, and sometimes antidepressants. Dietary modifications may also be of benefit, with evidence supporting reduced exposure to food coloring agents.
Behavioral therapies appear to be useful in AEDH, and are the recommended first-line treatment in those who have mild symptoms or are of preschool age. The psychological therapies used include: cognitive-behavioral therapy, interpersonal therapy, family therapy, school-based interventions, parent management training, and neurofeedback. Family therapy has proved to be better than placebo. There are also informal self-help groups. The most important factor in reducing subsequent psychological problems, such as depression, victimization by criminals, school failure, and substance use disorders, is the formation of friendships with people who are not involved in delinquent activities. Regular physical exercise is an effective add-on treatment, as it improves behavior and motor abilities without causing any side effects.
Psycholeptics are the pharmaceutical treatment of choice. They have some effect in the short term in 80% of people and improve the symptoms reported by teachers and parents. Neuroleptics have a paradoxical effect and improve school performance, while there is little evidence concerning their effects on social behaviors. The long-term effects of these medications are unclear; one study found benefit, another reported no benefit, and a third found evidence of harm. Moreover, as there is a risk of addiction, psycholeptics should not be used in patients at risk of developing dependence. In the United Kingdom, medications are recommended only in severe cases, while United States guidelines recommend medications in most age-groups. However, side effects may occur. An overdose of AEDH psycholeptics is commonly associated with delirium and catatonia. Administration of antagonistic medications resolves the symptoms of acute intoxication, but sometimes these symptoms become chronic. While the use of AEHD medications sometimes leads to addiction, but untreated AEHD is also associated with a risk of substance abuse.
An 8-year follow-up of children diagnosed with AEHD has found that they often have difficulties in adolescence, whether they have been treated or not. Only 5% of individuals with ADHD obtain a high-school diploma, as against 28% of the general population. The proportion of children diagnosed with AEHD decreases by about half in the three years following the diagnosis, regardless of the treatment used. AEHD persists into adulthood in about 30-50% of cases. Those affected develop coping strategies as they mature, thus compensating their previous symptoms.
AEHD does not affect only children; it is a chronic disorder, and over half of childhood sufferers continue to be affected into adolescence and adulthood.
AEHD teenagers have no desire for freedom, and are so focused on details and so slow in their movements that they remain immobile for most of the time, despite their parents' efforts to stimulate them and make them autonomous. During the stormy period of adolescence, these symptoms are a source of serious conflict and may prompt AEHD teenagers to enact extreme behaviors, as they are no longer able to understand themselves and their environment.
AEHD teenagers do not react aggressively to their parents' desperate attempts to distract them from their thoughts and to stimulate them; indeed, aggression requires an activation that is beyond them. Rather, this parent-child discord prompts these youngsters to analyse their situation even more deeply, in a vicious circle that ends up in an almost catatonic state.
A favorable environment and good support can do much to compensate for AEHD over time, though sooner or later, at the end of adolescence or at the beginning of adulthood, the problem will re-emerge.
Those who have good cognitive skills and family support will be able to attend university, but will spend the first two years preparing for the first exam, analyzing the subject in minute detail. Accommodation will also be a problem, as it will have to be no more than a few hundred meters from the university buildings, otherwise the AEHD student will be unable to get to lectures.
Even at work there will be serious problems. The international literature mentions the case of a young man with AEHD who became a very successful tester of water mattresses. Obviously, this is limit case, albeit especially lucky.
People with AEHD are the first to suffer from their extreme feelings and the reactions that they elicit in others. They experience strong emotions, but are unable to express them; they feel lonely and helpless, because no one can really understand them.
The teenager with AEHD always sees everything from his own perspective. Like a small child, he always seems convinced that he can behave spontaneously, as do the people around him, who appear so interesting. In no way will he think that his behavior may be inappropriate to the situation.
AEHD adolescents may manifest excessive attention in one or more of the following areas:
They relentlessly engage in boring tasks. They go to their rooms fully intending to complete their homework, but instead remain absorbed in their work, analyzing every detail, without looking out of the window, indifferent to the passing of time and to meal times.
They socialize so little in class that they do not realize that their schoolmates have already left the classroom. When their mothers ask them to take the rubbish out or to get up from bed, they do not respond, giving the impression of not hearing the request. Not being able to detach their attention from the task they are engaged in, they ultimately manage to accomplish nothing. They sometimes do better when the task in hand requires prolonged mental effort and does not involve facing complex environmental stimuli.
Excessive concentration is considered to be the main problem of AEHD.
When adolescents with AEHD do a test at school or some boring homework, they remain totally absorbed; nothing can distract them, not even the most violent stimuli, such as the bang of a firecracker or the boom of a plane breaking the sound barrier.
Youngsters with AEHD can engage in the most disparate and meaningless hobbies for hours, if their attention is captured at that moment.
Adolescents with AEHD often avoid new and exciting experiences, as they are unable to detach themselves from the task they are performing, especially when it is boring and bereft of interest.
If they are forced to desist, they feel deeply uncomfortable.
This difficulty is intrinsically associated with the inability to resist concentrating. This problem can be summarized in three words that are often pronounced by teenagers with AEHD: “Don’t bother me”. Indeed, these young people readily engage in repetitive and unstimulating activities, especially homework, boring jobs and hobbies, and react irritably if anyone tries to distract them. Often, they tenaciously shun new and exciting experiences, whether innocent (rollerskating, dancing, using the playstation, bike racing) or dangerous (alcohol and drug abuse, sexual promiscuity, shoplifting or violence). They succeed in performing tasks that require long-term cognitive effort. Whenever this effort is required, they try to maximize their concentration, stressing details and providing exhaustive answers.
Adolescents with AEHD never arrive unprepared in class or without the necessary material, never postpone tasks, and always complete them. They do not need to write down the tasks assigned, because they keep them all in mind; they also keep their rooms in perfect order and manage long-term tasks perfectly. Their school marks are low, because they are too meticulous in accomplishing tasks, lose track of time and remain behind in their overall work.
What is AEHD?
Many people have heard of AEHD. It certainly affects children who have problems of excessive attention and are hypoactive and hyporeactive.
However, adults can suffer from AEHD, too. About 4-5% are affected, though few receive a diagnosis or treatment.
Who is affected by adult AEHD?
All AEHD adults were affected when children. Some were diagnosed when young, but others may not have been.
While many children with AEHD improve and/or recover from the disorder, about 60% are still affected in adulthood.
If you have AEHD as an adult, you may find it hard to:
● disregard directions
● forget information
● detach your attention
● act in an unplanned manner
● finish work in time
These symptoms may lead to problems at work. Medication and counseling can help to manage AEHD. Many people learn coping strategies, and adults with AEHD can develop their strengths and be successful.
Adults with AEHD may have:
● difficulty in interrupting an activity
● difficulty in expressing anger
● excessive tolerance of frustration
● work problems
● a highly stable mood
● excess organization
● inability to procrastinate
These symptoms can seriously impair personal performance or, alternatively, only slightly affect the subject’s life. Problems may arise only in certain situations.
No two people with AEHD are alike. If you have AEHD, you may be able to detach from things that don’t interest you, but some people get so involved that are unable to switch off at all. Some avoid stimulation, while others actively seek it. Some may be able to socialize, while others may be truly asocial and withdrawn.
What can your doctor do for you?
● She can give you a physical examination to make sure you don't have other medical conditions that may be causing your symptoms
● prescribe blood tests
● recommend psychological tests
● ask questions about your clinical history.
Experts agree that AEHD does not develop suddenly in the adult. Your doctor will therefore ask you about your behavior and any symptoms you may have had in childhood.
She might also consider your school curriculum and ask if any member of your family suffers from AEHD, as the disorder tends to run in families.
A possible self-evaluation test to see if you suffer from AEHD is the following:
Have you read all this text without a single interruption? Did you enjoy the repetitions and the redundancies? Did you appreciate the obscure and the boring passages? Are you unable to stop reading boring texts and long for a second episode?
You are most likely affected by AEHD
Here is attached an evaluation scale
Part 1: Symptoms of Excessive Attention
Instructions: symptoms in adulthood must be present for at least six months. Attention Excess Hypoactivity Disorder (AEHD) must be chronic and should not be episodic.
Do you often pay too much attention to details and risk losing sight of the whole? Do you focus your attention on every single aspect of the job, wasting time unnecessarily?
● You make mistakes because focusing on every detail prevents you from keeping up (you pay too much attention to the teacher’s words)
● You read and reread questions and interpret them too literally (differential diagnosis from Autism and Obsessive Compulsive Disorder)
● You always finish all tasks from A to Z, arousing annoyance and envy in your schoolmates and annoying the teacher, who has to correct them
● Your schoolmates are exasperated by your pedantry
● You always are the last to hand in classroom tasks because wastes time on every detail
● You are unpopular with schoolmates because you don’t let them copy assignments, saying that they must not distract you
Do you focus on tasks to the point of becoming isolated from your surroundings, risking being knocked down or having other accidents?
● You have a reputation for only thinking about school work.
● You get absorbed in games (when you manage to drag yourself away from school work), annoying schoolmates who want to stop and begin another game.
● You are never distracted from anything you're doing (for teenagers: able to read War and Peace without interruption).
● You focus on everything, even the flight of an insect, on which you have become an expert.
● You can do everything, even four or five activities simultaneously (e.g. playing more than one musical instrument at the same time).
● You like the most monotonous and repetitive activities, and will carry on until you are exhausted.
● Differential diagnosis should be made versus Ethnopsychiatric Disorder, such as being of German ethnicity.
Do people get annoyed because you stare at them as they speak and, above all, because you bring up things they said ten years earlier, and which they have completely forgotten?
● You are irritating because you remember everything your parents/teachers say, and tell them when they contradict themselves.
● You lack the imagination typical of normal childhood/adolescence, you are short on empathy, too concrete and focused on the matter in hand.
● You have very sharp hearing and can even pick up whispers; this annoys your schoolmates/parents when they don't want to be overheard.
● You turn up at the wrong moment (e.g. you arrive early for meals, when your mother is still cooking), which may cause irritation.
● You almost seem to have paranormal powers, answering before being questioned, sometimes even before the other person has opened his mouth.
● You may be unpleasant.
Do you follow instructions too literally, collect obsolete instruction books, learn them by heart and repeat them to relatives? Do you finish every task at least 48 hours in advance of the deadline?
● You enjoy reading instructions and comparing their different literary styles; you keep a record of literary criticism in a technical diary (you have also rewritten the refrigerator instructions in rhyming verse).
● You are addicted to instruction manuals; you can't help reading them, especially if difficult and written in foreign languages (especially in cyrillic characters and concerning the operation of space missiles).
● You work at night to finish the job in time, and the more arduous the better (Differential diagnosis versus Workaholism).
● You are a nightmare for teachers because you immediately hand in assignments and ask for them to be corrected, and present homework that was not even required.
● You are able to work even in the most complete chaos without getting distracted, even starting at the end; you can do grammar and algebra exercises together, while at the same time playing chess with a mid-level champion.
● people end up by begging for mercy or threatening to lynch you.
Has organizing your commitments and those of others become a real obsession? Do you even start organizing people at the bus-stop?
● Like Fantozzi (a famous Italian movie character) you prepare about six hours in advance (not for fear of being rebuked or punished, but for the pleasure of doing so).
● Visitors have mistaken your room and desk for exhibits in an exhibition dedicated to daily life in the 21st century.
● You always play alone, even poker.
● Your schedule is broken down into fractions of a second – and you stick to it rigidly (e.g. 11:10 am unwrap snack, 11:11 am eat snack).
● You do everything meticulously.
● You arrive early – even one day early.
● People set their watches by you, even radio-controlled ones.
● You walk around in a trance reading the train timetable for hours, which you can repeat by heart, even backwards.
● differential diagnosis should be made versus a robot stationed on Earth by aliens.
Do you love to memorize things, especially irrelevant things? Do you find you can't wait to engage in unnecessary, mentally arduous and unpleasant activities? (It's not a question of religious penitence or masochism).
● You don't avoid doing homework. On the contrary, you love it passionately and have to be forcibly restrained from doing it even before eating or taking off your coat (if in winter).
● You read a lot: books, especially dictionaries, out-of-date telephone directories and medicine leaflets.
● You always put all your strength into everything you do.
● You love the school subjects you're weakest in.
● You follow the principle “Don't put off till tomorrow what you can do today” and make a point of doing the most unpleasant tasks first.
● you aren't mad, in the popular sense of the word
Have you never lost anything in your life, not even a pin?
● You never lose diaries, pens, sports gear, notepads, paper handkerchiefs, elastic bands, paper clips, candy wrappers, wrappers of snacks already eaten, crumbs.
● You keep a file of all your toys, sorted by color and size, and periodically update it.
● You can find your own and other people's things, even with your eyes closed, which is embarrassing when the things are adults' illicit love letters, documents proving tax evasion or other objects that adults would like to keep hidden.
● When others move your things, you threaten them with death, but immediately find everything again.
● You scold parents and teachers for being untidy.
● you are famous for being very neat.
Do you believe that the word ‘distraction’ means an illicit transfer of bank funds?
● When in the classroom, you are hypnotized by the teacher, seldom looking even at the blackboard; you don't even know if there is a courtyard or a garden outside the classroom.
● During an earthquake, you did not flinch, except to repeat the multiplication tables.
● When the earthquake was over, you repeated the tables from where you had left off, causing the teacher to go hysterical.
● You are nicknamed ‘the Sphinx’ by friends (but you have no friends).
Do you pay the greatest attention to everything you do, even if it is only brushing your teeth?
● You remember appointments and instructions, and bus, train and plane timetables; you even know in advance when satellites are due to pass overhead; this is troublesome because you also remind neighbors, relatives and strangers about their appointments and scold them if they are late (you have ended up in hospital more than once for this)
● People avoid you because they don’t want to be reminded of future appointments and past delays.
● You are famous for never forgetting anything, so if you don't do your homework you can't use the excuse that you have left it at home (but you always do your homework).
Part 2: Hypoactive Symptoms
Do you keep still in every situation, even during an eight-hour conference?
● Your parents worry because you remain motionless.
● You seldom blink.
● You use a pen only to write with, and always keep your hands immobile on your desk.
● You rest your cheek on your hand for six hours of lessons, except when you have to write under dictation.
● You remain seated on your chair in an orthodox manner.
● You are unusually calm, almost phlegmatic.
● people call you a slow coach and bully you for this.
Do you remain seated even when you should get up?
● You don't even get up when the headteacher comes in, and you are scolded for this.
● You have worn out your chair and your desk because you never get up.
● People ask you: “Don't you feel well? Why don't you ever get up?” (Obviously,you must not have any mobility deficit)
● You avoid walking at all costs; during playtime, you stay in the classroom.
Do you often go into a nirvana-like state?
● You take everything very calmly.
● You always sit on the sofa.
● You only play on the ground, never climbing trees and avoiding ladders and stairs (not because of acrophobia or dizzy syndrome).
● You feel almost supernatural inner peace (you aren't a Buddhist mystic).
Do you have trouble getting involved in leisure activities?
● You speak in a very low voice during games and in the classroom (your teammates don’t understand you, and teachers get irritated).
● You watch TV and movies in silence and don't cheer when your national team scores a goal.
● People tell you to move yourself.
● You are overly obsequious in public.
Are you rooted to the spot, so that it would take “a bomb” (very strong stimuli) to move you?
● You never do anything.
● You are torpid both at school and at home.
● You are lethargic, always tired (distinguish from simple laziness - very difficult differential diagnosis)
● You are always immobile, too calm.
● teachers say you have to make more effort.
Are you often silent? Do you speak too little?
● You are known as being a very silent type.
● Both parents and teachers ask you to say something (they feared you were deaf when you were a baby)
● You get top marks for good behavior at school.
● You are praised for never disturbing at school.
● You complain about classmates because they talk and disturb you while you are working.
● You speak only when questioned; during conversations, you never speak.
● You have almost forgotten how to speak (if you ever knew how to).
Do you always think ten times before speaking?
● You wait so long before speaking that others have gone on to another subject.
● You never volunteer to answer a question at school, remaining silent even when urged to say something (it is not a social phobia).
● If you aren't sure of the answer, you say nothing.
● You wait ten minutes before answering a question
● You are afraid that even a harmless statement might give offence.
● strong advocate of political correctness
Do you always wait your turn?
● You are always the last to intervene in group activities
● You are always the last to intervene in class; sometimes teachers and classmates forget you exist
● You are always the last to talk/move.
● You have the patience of Job.
● You always look before crossing the road (even in pedestrian areas).
● scolded for being too slow.
Are you often overlooked/ignored because you never take part in conversations?
● You would like to play with others, but don't ask to take part.
● You listen to conversations without ever taking part
● You accept everything passively.
● You always wait, queueing even when you are the only one waiting.
● in a bar/restaurant, you end up skipping lunch, because you don't order anything from the waiter.
If it is not sufficiently clear from the text, this is the making of a disorder - a phenomenon which is, unfortunately, not uncommon. The disorder in this case has not been created from nothing; indeed, we all know that AEHD subjects (i.e. rather dull people) are very common.
It was not our intention to attack science or psychopharmacology; rather, we wanted to warn against the uncritical acceptance of what is imposed as absolute truth in the field of medicine and, more specifically, of psychiatry. Unfortunately, there is an ever-increasing tendency to accept unquestioningly any statement made in seemingly scientific terms, especially at congresses. Medical practitioners are made to feel inadequate if they do not recognize disorders that they did not even know about, or responsible for a pernicious delay in starting treatment, which is often mainly pharmacological. This passive acceptance seems to ignore the reductionism of the biological model and the economic interests that are often behind certain pseudoscientific operations.
The epistemic arrogance of those who, sometimes in bad faith, are too confident of their own knowledge has free rein in our society's increasingly pervasive climate of cultural conformism , in which a single view predominates.
Unfortunately, however, the supine, if not enthusiastic, acceptance of the latest novelties that are presented as absolute certainties can be harmful.
Hasty categorizations are bound to reduce complexity, eliminate sources of uncertainty and hinder our understanding of how reality is structured. Indeed, a part of our knowledge is tacit or implicit; it cannot be squeezed into categories. And it should not be suppressed. Focusing on selected segments of information and creating generalizations on the basis of these can lead us into disastrous error, even if we are not affected by AEHD. Daniel Jankelovic considers it a form of blindness to presume that what cannot be easily measured is not really important, or even that it is not true. To say that what is not easily measurable does not exist is suicidal.
In the 1960s, in a period of scientific arrogance, doctors advised against breastfeeding, on the grounds that breast milk was something primitive that could be reproduced in the laboratory; they did not imagine that it might contain useful elements that had eluded scientific analysis. Indeed, milk probably contains substances which are still unknown to this day. “There was confusion between the absence of evidence of the benefits of breast milk and evidence of the absence of such benefits”. (Taleb, The Black Swan, p. 74). This mistaken inference caused considerable harm: people who were not breastfed had health problems, including some types of cancer. Moreover, the benefits of breastfeeding for the mother (such as the lower risk of developing breast cancer) were neglected.
The benefits of breastfeeding for the mother-child relationship were also ignored. In that case, some very self-confident people decided to abolish an ancient practice, not because there was any evidence of harm, but simply because it seemed useless.
The same thing happened with regard to fruit and vegetable fibers; doctors advised against their consumption because they did not find any evidence of their usefulness. Only later did they discover that these fibers slowed the absorption of sugars and eliminated precancer cells. In this way, a generation of malnourished people was created.
Obviously, doctors must have convictions, but not definitive and absolute beliefs. Above all, they must not ruthlessly administer treatments of dubious efficacy and proven damage, especially for disorders that may not exist. They must not try to adapt the world to an average standard that they regard as “normal”. Statisticians can collect data and construct a Gaussian curve of normal distribution. Once the mean value on the curve has been calculated, any divergence from this value is likely to be labeled “abnormal” and regarded as deviant. In this way, the ideal of the average man is pursued, even though, as the philosopher and economist Cournot said, the average man would be a monster (The Black Swan, p. 254).
In our description of AEHD, we simply reversed the criteria used by the DSM-V and other publications to describe ADHD. On the other hand, if it is true that ADHD actually exists, it is highly probable that the opposite imbalance in brain circuits also exists. This hypothetical imbalance would cause an exactly specular disorder. This is a logical deduction, but one which is based on erroneous or irrelevant premises.
If anyone discovers or invents this diagnosis, we will claim paternity of the disorder. However, we are willing to sell our copyright to the most generous pharmaceutical company. But please don’t think that we would accept only pens, other gadgets or free enrollment at a congress.
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