Friday, December 20, 2013

Confusing strawmen arguments with the knowledge frontier

I think this article, The False ADHD Controversy by Ross Pomeroy, rather misses the point.

Pomeroy is focused on making the argument that ADHD exists and to some degree, he makes his point in the article. Fair enough. But is that perhaps a strawman argument? Is there anyone who actually argues that ADHD does not exist at all? Surely not, or not in sufficient numbers to register on the radar screen of public discourse.
More kids are being diagnosed with attention deficit hyperactivity disorder (ADHD) than ever before, according to the Centers for Disease Control. 8.8% of children were diagnosed in 2011, compared with 7.0% in 2007.

An uptick was also witnessed in the number of parents choosing to medicate their children with stimulants such as Ritalin. That proportion now sits at two-thirds.

ADHD is perhaps childhood's most common neurobehavioral disorder. It's characterized by an array of symptoms, including squirming, excessive daydreaming, forgetfulness, and hyperactivity. Scientists still can't precisely pinpoint what's going on in the brain to trigger ADHD, but it's evident that something is amiss. Children with ADHD generally have reduced brain volume in the left pre-frontal cortex.
Surely the argument is two-fold: causation and degree.

Causation is open. I don't think anyone would argue that they know what is going on with the ADHD diagnosis numbers. It is in part genetic, maybe epigenetic, certainly to some degree environment and or social. It is an issue that is complex and causally dense.

Degree - what does it mean that in the US we now diagnose 9% of children with ADHD when once upon a time, we didn't recognize it at all or diagnoses it in the 1-2% range? What does it mean that the UK diagnoses ADHD at half the rate that we do in the US? Are they under-diagnosing or are we over-diagnosing? What is the real base line of diagnosis? We don't know. Is there a binary definition of ADHD or is there simply a continuum of conditions? It is a continuum which means that there is a subjective element in the discussion.

ADHD is a causally dense, complex issue and shares many characteristics with similar causally dense complex issues. They are usually important and consequential issues with multiple root causes whose interdependencies are complex and unknown, which are prone to hidden feedback loops, tipping points, and extreme sensitivities.

Is ADHD real? Sure. Do we know what the "real" baseline prevalence in the general population is? No. Do we know the causes of ADHD in a predictive fashion? No. Are the variances in diagnoses large? Very.

Like anthropogenic global warming, mental health, nutrition, poverty and education, income inequality, with ADHD we are operating beyond the knowledge frontier. Within the knowledge frontier we know baselines, variances, and causes. We can make usefully accurate predictions. Beyond the frontier, our knowledge is too sketchy to display any of those characteristics.

It doesn't mean we do nothing. We explore, we test, we experiment. But above all, we maintain cognition and humility. We don't yet know what we are talking about.

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