Currently, in many countries a wide variety of children are being classified as having ADHD and placed on a regimen of consuming psychiatric drugs. Supporters of this trend often cast a disrespectful eye toward their critics while arguing that scientific research supports their position. Meanwhile, equally scientific minded individuals who have looked at the same research come up with a completely different set of conclusions. So, about once a year I take a look at the most current research to see if I can throw some light on this topic.
Last year, for example (see HERE), I reported on a study that suggested that:
Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) show decreased bone density, according to a large cross-sectional study that appeared in the Journal of Pediatric Orthopaedics.
I also reported last year on another study that provided the latest replication of other studies indicating that drug treatment provides no lasting benefits for students classified as having ADHD.
Factors looked at were academic achievement and social functioning. Although the medicated ADHD students didn’t do any better or worse on these measures then the unmedicated ADHD students, they did endure many uncomfortable side effects while they were on the ADHD drugs, such as sleep problems, headaches, stomach aches, and feelings of depression each evening when the drug wore off. Thousands of dollars per child were consumed on purchasing the medications that achieved some modest short term gains but had no lasting positive effects.
How about this year? Are there any new studies that throw light on the ADHD controversy?
The Latest Study
The April 2017 issue of Lancet Psychiatry contains a write-up of a study that looked at the largest data set to date to see if people who have been labelled as having ADHD had some difference in certain regions of their brains than people who were not labelled (the control group). The sample comprised 1713 participants labelled as having ADHD and 1529 controls from 23 sites with a median age of 14 years (range 4–63 years).
Of the 8 areas of the brain that they looked at using MRI scans, 6 were statistically smaller for the group of ADHD labelled people when compared to the control group, but this statistical difference was only found for the group of children younger than 15. When the study looked at these regions of the brains of adults, there were no statistically significant differences.
The authors claimed that their analysis supports the theory that ADHD is due to a delay in the brain maturing. Finally, they concluded that their study contained important messages for clinicians: “The data from our highly powered analysis confirm that patients with ADHD do have altered brains and therefore that ADHD is a disorder of the brain. This message is clear for clinicians to convey to parents and patients, which can help to reduce the stigma that ADHD is just a label for difficult children and caused by incompetent parenting. We hope this work will contribute to a better understanding of ADHD in the general public” (p. 7).
Media Coverage of the Latest Study
Even before the study was published in the April 2017 issue, media outlets rushed to cover the story. Here is a sampling of headlines:
Critical Analysis
Shortly after the publication of this study, two people with impressive scientific credentials, Michael W. Corrigan, Ed.D. and Robert Whitaker, thoroughly analyzed it, and concluded that the study is very misleading and they are calling for it to be retracted. Their entire analysis, which I highly recommend, is available for free HERE. For my readers, I will summarize a few of its key points.
The authors refute the study’s conclusion that it found that people labelled as having ADHD have smaller brain volumes. Thus they state:
“In this study, the authors pooled together MRI brain-scan data for the 3,242 participants in the study (which had been collected and archived at the 23 sites), and then calculated, for each cohort, mean intracranial volumes and mean volumes of specific brain regions. They reported the differences for each of these comparisons and the “effect size” of the differences. This is the critical aspect of the results to consider and understand: effect sizes reveal the true strength of the findings and how much overlap there is between the individual brain volumes in both groups, and thus establish the likelihood that an individual in the ADHD group has a smaller brain volume than an individual in the control group.
The biggest effect size that was found was .19. This was for differences in the mean volume of a region known as the accumbens for ADHD labelled children under 15 years of age. An effect size of 3, which is the largest effect size one can obtain using this type of statistic, would have suggested that pretty much all of the children in the study that were labelled as having ADHD had a distinctly smaller volume in that region than controls. An effect size of 2 would have suggested a distinctly weaker relationship and that some of the children in the ADHD group did not have smaller volumes than the control group, some in the ADHD group had larger volumes than the control group, and some of the control group had smaller than average volumes in that region and yet showed no signs of ADHD. An effect size of 1 would have indicated even a weaker relationship. The effect size of .19 is less than a fifth the size of 1, that is, about a small an effect size as you can imagine. (To learn more about what an effect size is, access this article by Robert Coe: It’s the effect size, stupid.) The critique summarizes this issue as follows:
“In short, if you just flipped a coin to guess which of the two cohorts the child belonged to, your odds of being right would be nearly the same. The diagnostic value of an MRI brain scan, based on the findings in this study, would be of little more predictive value than the toss of a coin.”
Perhaps the best way to understand this is to look at the individual site data. Thus, the study’s authors reported that the “volumes of the accumbens, amygdala, caudate, hippocampus, putamen, and intracranial volume were smaller in individuals with ADHD compared with controls in the mega-analysis” (p. 1). If this is true, then smaller brain volumes should show up in the data from most, if not all, of the 21 sites that had a control group. But that was not the case.
Here are summaries of individual site results:
- Mean accumbens volumes: At 4 sites, the volume for the ADHD cohort was actually larger than for the control, and at another 6 sites, the mean volumes were basically of equal size.
- Mean amygdala volumes: At 5 sites, the mean volume for the ADHD cohort was larger than for the controls, and of equal size at 4 others.
- Mean caudate volumes: At 5 sites, the mean volume for the ADHD cohort was larger than for the controls, and of equal size at 2 others
- Mean hippocampus volumes: At 7 sites, the volume for the ADHD cohort was larger than for the controls, and of equal size at 4 others.
- Mean putamen volumes: At 5 sites, the volume for the ADHD cohort was larger than for the controls, and of equal size at 1 other.
- Mean intracranial volumes: At 5 sites, the volume for the ADHD cohort was larger than for the controls.
“The problem here is obvious,” says the writers of this critique. “If the authors are claiming that smaller brain regions are a defining ‘abnormality’ of ADHD, then such differences should be consistently found in mean volumes of ADHD cohorts at all sites. The fact that there was such variation in mean volume data is one more reason to see the authors’ conclusions—that smaller brain volumes are a defining characteristic of ADHD—as unsupported by the data.”
The critique goes on to mention a number of other serious problems with this study. For example, in a scientific study we look for possible sources of bias. The critique correctly points out that this study was written by an authors’ group that included many who had close ties to pharmaceutical companies that sell ADHD medications. We can also surmise that some, if not all, of the authors who do not currently have ties to these pharmaceutical companies may hope to land in the future financially rewarding speaking fees sponsored by these companies.
There are many other serious weaknesses with this study that the critique points out, but since it is readily available for free, I’ll end my summary here. My own conclusion is this. The study’s results are highly questionable. 
Particularly troubling is the suggestion by the study’s authors that their findings will help to reduce stigma. How in the world does telling people that ADHD people have smaller brains help to reduce stigma for that group of people? Moreover, even if we found enough evidence to conclude that there are some differences in the brains of people being labelled ADHD, this would still not lead us to conclude they have a brain disorder. A difference is not automatically a disorder. Having people with different brains can be a wonderful thing. For example, it can mean that some people will prefer to work sitting all day, while others prefer to do work requiring lots of activity. We need both types of people, and other types as well, to enrich our lives.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
For example, in this panel from a recent comic, we see a caricature of Trump insulting several news outlets. Whenever the president has been asked why he has been utilizing these types of insults, he claims that the other side started it. He’s just getting back at them, he explains, because they insulted him first.
In the comic, TRFF, the guy with a mustache and cigar, views himself as an authoritarian and is just delighted that he has been appointed Deputy Director of Payback. Let’s begin our exploration below the surface with a quick discussion of what it means to be an authoritarian.
“An authoritarian leadership style is being used when a leader dictates policies and procedures, decides what goals are to be achieved, and directs and controls all activities without any meaningful participation by the subordinates. This leader has full control of the team, leaving low autonomy within the group.
Perhaps one of the best known leaders who embodied the authoritative style of leadership was Nelson Mandela. After serving 27 years in jail for seeking justice for the majority of South African people, he had plenty of reasons to seek payback. But in a speech delivered to the European Parliament in 1990, he stated:
In contrast to the image that many people have of Nelson Mandela’s leadership style, take another look at the caricature in the Doonesbury comic of a authoritarian in charge of payback for the president’s administration. As a response to some guy who is disloyal to the administration, TRFF says that if it was up to him, he’d throw the guy out of a plane. TRFF is just loving the fact that he gets to demean, threaten, or fire people every day.
In the short run, there are people who are willing to Kowtow to them, but there is a spirit within that slowly begins to get riled, and danger lurks below. It is not always easy to see this in the muddy complexity of large organizations, but search your own heart and you will know of its existence.
A while back, I heard about a company that had been having a hard time getting its workers to arrive on time. The company executives had a policy of punishing those who came late by docking their pay. Not only didn’t this work well, but the workers became bitter toward the executives, and many workers, after being trained at great expense, would soon leave for employment at competing companies.
Recently, President Trump advocated that the current US health plan be replaced with a new health care law. He was unable to get enough votes for its passage. Will he now unleash the dogs of payback? Should he?
Welcome to From Insults to Respect. Today we take up the question, can the science minded and religious minded legitimately take up an attitude of mutual respect?
There are, of course, people who fervently believe that opinions that do not rest firmly on the broad shoulders of scientific evidence are nothing more than superstition. Many of these individuals, as soon as they hear that a person is religious, give off vibes of disdain.
Meanwhile, there are religious folks who believe that science minded individuals have led to a world of atomic energy catastrophes, billowing coal chimneys, people with their noses in their devices while tending to their babies, etc. In their hearts, these religious folks angrily believe that the science minded are leading humanity down a filthy, destructive path.
Then there are people who richly agree with Albert Einstein when he wrote, “Science without religion is lame, religion without science is blind.”
“First, what is the nature of it? what is its constitution, origin, and history? And second, What is its importance, meaning, or significance, now that it is once here? The answer to the one question is given in an existential judgment or proposition. The answer to the other is a proposition of value…. Neither judgment can be deduced immediately from the other. They proceed from diverse intellectual preoccupations, and the mind combines them only by making them first separately, and then adding them together.”
Religion, in contrast, seeks to deliberately nurture the moral sense. For Einstein, “A person who is religiously enlightened appears to me to be one who has, to the best of his ability, liberated himself from the fetters of his selfish desires and is preoccupied with thoughts, feelings, and aspirations to which he clings because of their super-personal value.”
Did Laura and Harry make the right decision? The question may seem easy if they had a great time and came back uninjured. But what if they had had a terrible accident? Would this require that they conclude that they had made the wrong decision? Can science answer this question?
Now, some science minded folks well recognize that some decisions must be made before the availability of sufficient scientific evidence. They argue that in such cases, they don’t need any religion to tell them what is right and what is wrong, they can decide that perfectly well on their own. I, for one, am on friendly terms with these people. I am not seeking to force religion on them. At the same time, I know there are people who choose to participate in a religion, valuing the stirring lessons from their clergy, the social connections, and the community support for worthy causes. They choose to use some of what they experience by being a member of their religion to make some of their decisions. I, for one, am on friendly terms with them. I don’t see the sense of automatically disdaining either the science minded or religious minded.
Some people in the science camp like to point to several religious related incidents, such as planes crashing into the World Trade buildings, in order to condemn all religion. But there were people in the science camp during the religious hating Soviet Revolution that participated in the slaughter of millions. Moreover, during the Nazi regime, Hitler found plenty of science minded people willing to aid in the carrying out of atrocities.
Perhaps the greatest difficulty science minded people have with religion is that it promotes magical thinking. I hasten to point out that not all religions do so. For example, the Transcendentalists, with Ralph Waldo Emerson as one of their most eloquent writers, embraced principles of science. The Dalai Lama, as well, presents us a religion very open to what science can teach us.
Let me add as well, with regards to this magical thinking issue, that many people who view themselves as religious, well recognize the magical thinking that appears in their scriptures, but do not accept them. Instead, they view them as comforting to those who don’t have a scientific mind, then they slip by those sections of scripture to those that they more highly value. We can liken it to a guy who recognizes that his mother holds some beliefs with which he completely disagrees, but he continues to love her for all the other aspects of her life that so beautifully nourishes his existence.
This one has to do with the wisdom of remaining skeptical until we have sound science evidence to support our position. I can see some merit in that. At the same time, in real life circumstances, a question comes up regarding just what is the point at which our opinion should be coerced by the existence of sound science? Bear in mind that there was not so very long ago a procedure known as lobotomies. This brain surgical procedure was viewed as being backed by such solid scientific evidence that powerful people were able to involuntarily subject less powerful folks to the scalpel. It didn’t turn out well, at least not for those who had part of their brains gouged out.
So, there are good people who are hesitant to accept what science folks tell us. Is it wise to treat them with disdain, or to remain on friendly terms with them while respectfully disagreeing?
James points out that in most areas of human life, science simply has not come far enough to determine with any great precision what is the most favorable road to travel. The variables that in a controlled lab seem somewhat predictable frequently become entangled in so many other variables out in the more natural world that we must make decisions as best that we can, guided by nonscientific lights. Having some faith, even without sufficient scientific evidence, may be helpful.
For James, some people possess a strong religious sense, others less so, and others find a void in that section of their brain. Where is the evidence that any one of these types are somewhat less human, or less worthy of respect? Perhaps there is some value in having some diversity within the human species.
One day I was watching Donald Trump’s first news conference since he became president. There, the remarks that I found most interesting had to do with his expressed outrage about how hateful the press has been toward him. The first time it came up, he was asked the following question by a reporter:
“Well, the leaks are real. You’re the one that wrote about them and reported them, I mean the leaks are real. You know what they said, you saw it and the leaks are absolutely real. The news is fake because so much of the news is fake. So one thing that I felt it was very important to do — and I hope we can correct it. Because there’s nobody I have more respect for — well, maybe a little bit but the reporters, good reporters.
“And if I may follow up on that, just something that Jonathan Karl was asking you about. You said that the leaks are real, but the news is fake. I guess I don’t understand. It seems that there’s a disconnect there. If the information coming from those leaks is real, then how can the stories be fake?”
A great model to consider as an alternative to Trump’s style is that of John F. Kennedy’s. Over the whole of his presidency, Kennedy averaged a 70.1 percent approval rating, comfortably the highest of any post-World War II president. By comparison, the average for all presidents between 1938 and 2012 is 54 percent. Trump, last I looked, was at about 40 percent.
Perhaps he has come to believe that many of his most ardent supporters actually believe him when he lies, and it is the media who are telling the lies. Trump may also believe that others of his supporters don’t care that he lies because they believe business folks always exaggerate as they promote their goals, and that Trump is just promoting causes that match their values. Many Americans may therefore see his behavior not as a sign of mental illness, but simply that he is a shrewd businessman.
“I should note that nothing I am saying should besmirch the reputations of men like President Abraham Lincoln or Sir Winston Churchill, both of whom are said to have fought the ravages of major depression or bipolar disorder. One was instrumental in ridding America of slavery. The other was instrumental in saving the world from tyranny. Mahatma Gandhi, by the way, also reportedly suffered from depression. Psychiatric illness does not, a priori, disqualify a person from rendering extraordinary service to mankind.”
In the February 14, 2017 edition of the New York Times, there appears a 
“Although no definition can capture all aspects of all disorders in the range contained in the DSM-5, the following elements are required:
Judy becomes bitter when she finds out that her husband, Glen, lied to her. That bitterness leads to a loss of the tenderness she had for him on their glorious wedding day. Despite efforts by Glen to straighten things out, his previous loving relationship ends in divorce.
As regular visitors to this blog well know, it is my habit of utilizing, from time to time, Bob Dylan’s Theme Time Radio Hour show to provide a literary spin on a topic of interest. To that end, today we’ll turn to his wonderful episode that focused on the theme, “Truth and Lies.” You can listen to the show for free by clicking 
If the truth will hurt someone you love, 
If you are going to tell a lie, make it a white lie. The dictionary defines that as an often trivial, diplomatic, or well-intentioned untruth. According to a survey, 4 out of 5 people admit to telling white lies at least once a day, and I’m telling you that that other guy, he’s lying.
Even if lying is a sin, it is only a venal sin. It becomes a mortal sin only when the intention of deceiving risks mortal consequences. And just as a reminder, here are the seven deadly sins: pride, envy, anger, sloth, greed, gluttony, and lust. Let me see, I’m good for about five of them.
“Don’t Play that Song” was a major hit not only for Aretha, but for several other musical artists. Its popularity is due, at least in part, to it so powerfully capturing the emotional pain that many experience when it becomes apparent that the person they fell in love with has lied about loving them. Such painful memories can last a lifetime.
Well, let’s talk it over
A liar lies to nations
When I was very young, I lied without any forethought. For example, I remember when I was in second grade, one day in the lunchroom a boy at my table announced that he just got a toy Tommy gun for his birthday. Seeing the enthusiastic reaction of some of the guys at my table, I announced that I got one also for my birthday, despite the fact that I hadn’t, and I didn’t even know what a Tommy gun was. The lie just shot right out of my mouth.
One of the biggest influences on my ability to have some forethought when it came to lying was meeting a couple of people in high school that displayed a degree of humbleness. I came to admire this. Both appeared comfortable about their shortcomings, and although both had some impressive skills in a few areas, rather than bragging about them, they let their performance speak for themselves. I soon found myself modeling their style, and each time I was tempted to exaggerate something about myself, I found I could catch myself beforehand, and pretty often I chose a more truthful path.
Empathy, as we have been lately discussing (see 
To give us a sense of the power of literature to promote empathy, Kathleen tells us about her own experience reading All Quiet on the Western Front by Erich Maria Remarque. The novel is based on Remarque’s experiences as a German soldier in World War I.
Professor Pinker notes that prior to the invention of the printing press there were very few books available. Those people who lived in the upper classes rarely had much direct contact with the lower classes. A nobleman’s quick glance while passing by a downtrodden worker often merely left the impression of a filthy, smelly soul, hardly human at all. After novels became available, a nobleman might read of a poor young woman pressed into very sad circumstances by a cruel person of the upper classes, and discover tears running down his cheeks. To discover that people all over the world, in all classes, and other religions have very similar desires, dreams, and feelings that we can all relate to, increases empathy and the desire to deal with a wider range of humanity in kind and respectful ways.
Of particular importance here is that their studies indicate that reading just any book is not likely to significantly improve empathy skills. Neither nonfiction or popular fiction did the trick. Only what they referred to as “literature” clearly enhanced empathy skills even though there was some indication that most folks liked the popular fiction best.
things–rock formations, how to do quilting, etc. If you choose to read one of these books it is because you share a common interest with the author. No time is spent on getting to intimately know people who have opinions and views that are much different than yours.
Consider as an exemplar, the movie Star Wars, a phenomenally successful form of popular fiction. Within minutes, we come to know who the bad and good guys are. And the bad guys are pretty much completely evil, and the good guys, ever so swell. Moreover, the plot is rather simple–the good guys have to kill as many bad guys as they can, with the ultimate goal of destroying their headquarters known as the Death Star.
For children within the age range of 4 to 8, I recommend the free guide titled “Developing Empathy Though Children’s Literature.” It has been published by the US government, and you can retrieve it on line at: 
The first in the trilogy is titled A Hero Grows In Brooklyn, and although you can buy an inexpensive paperback copy of it, I have made it available to be downloaded for free (For your free download, click 
Steve gets in his lunch line. The aroma of chicken soup, peanut butter sandwiches, and fried fish cakes drifts into his nostrils. He picks out a peanut butter sandwich, a container of milk, and some ice cream. Then he shows the cashier his free lunch pass. 
The other two novels in the trilogy take the same characters that we met in the first of the series into high school. More and more mature themes are addressed as they approach their date of graduation.
For adults, in addition to my own trilogy, I recommend making selections from the list of fiction finalists of the National Book Awards, which, each year, is readily retrievable from a Google search. For those who prefer short stories, O’Henry Award winners are great. Some of these stories were used in the research study published in the journal Science that was mentioned earlier in this post and found to increase empathy. You can find collections of these short stories by doing an internet search using the key words, “short stories, O’Henry Award Winners.
So, to me, empathy is a pretty good thing–I mean, what’s not to like?
“So, what they do when they give, is to give to a lot of different charities, and give a little bit of money to each one because for each one they get a little rush–‘Oh, I’m helping the blind babies. Oh, I’m helping the farm workers. Oh, I’m helping the chickens.’ The problem is that when you give a small amount of dollars to a charity, often it doesn’t do much good because the dollars they need to process your donation, in some cases, actually ends up with the charity taking a loss on your donation.” 
“Empathy’s engagement, being caught up in the suffering of victims, is usually the number one argument in a democratic country for going to war…. If we ever go to war against ISIS, a full blown military war, it will be motivated by our feelings for the suffering of their victims. But that’s just one consideration. Other considerations are, how many people will die in the war? How many other victims will the war create? But our empathy, our selfish moralizing, zooms us in and says, ‘Oh, my God, there are these people who are suffering, let’s bomb the crap out of them; Let’s destroy the whole country to save these people.’ And then people are later surprised that apparently we killed, you know, we killed 50 thousand people. Gosh, who would have known?”
It seems to me that the good professor confounds in his argument the experience of empathy with what one chooses to do when experiencing empathy. Yes, in some situations in which we experience empathy we could choose to take actions that in the long run causes more harm then good, but in other situations we act in enormously helpful ways.
Consistent with Dr. Bloom’s position, there is some evidence available that indicates that sometimes people will, upon experiencing empathy, act altruistic without much thought to the consequences. For example, in a 
This type of evidence is far from conclusive because the donors may have retrospectively distorted their accounts to present themselves in a favorable light. However, a number of other studies (see 
I think that Dr. Bloom’s real worthwhile point is not that empathy is bad, but rather, when we experience empathy we should be careful. If our empathy seems to be urging us to be helpful in some way, we would be wise to indeed consider the long term, as well as short term consequences of our actions. This, in truth, is how all of our decisions are best made.
The evidence supporting learning these skills includes studies demonstrating that prolonged stress is related to adverse psychological and physical health effects, as well as an increased risk of premature mortality (See 
There is some support for the “more skillful” theory. For example, in the Keller, et al. article, most of the people that these researchers studied believed their stressful experiences could make them ill, and indeed these folks did often experience more illnesses when they faced high chronic stressful experiences. However a resilient subgroup of individuals tended to not support the stress-illness connection. When faced with high stress, they had learned to believe that the physical sensations they experienced with stress was their body’s way to help them to rise to the challenges that they face.
The skeptics would like to see studies that first identified people who were having ill effects from too much stress, and then, after learning stress management skills, they ended up having better health outcomes than a randomly assigned control group who were not taught these skills. Without such studies, it can be argued that it is just a coincidence that those who appear to be skillful at dealing with stress happen to be individuals who are also healthier. These skeptics point out that there are already a few randomly controlled studies that have been completed that provided some brief stress-skill training to people experiencing heart problems. The results from these studies turned out to be discouraging.
Circulation, one of cardiology’s premier journals, published an article on March 21, 2016 titled, “
Patients engaged in aerobic exercise three times a week for 35 minutes. Patients also received education about coronary heart disease, nutritional counseling, and two classes devoted to the role of stress in this disease.
Patients in CR+SMT received the identical comprehensive CR intervention plus SMT. The SMT program combines education, group support, and cognitive-behavior therapy. The intervention is delivered in 12 weekly one and a half hour sessions in groups of 4 to 8 participants. Strategies for reducing demands are presented including prioritizing, time management, establishing personal values, and avoidance. Participants are encouraged to apply the skills that they have learned to address their own everyday problems.
Subsequent sessions focus on modifying responses to situations that cannot be readily changed. Several sessions are devoted to training in progressive muscle relaxation techniques and the use of visual imagery to reduce stress. Emphasis is placed on the importance of cognitive appraisals in affecting stress responses, with recognition of irrational beliefs and cognitive distortions such as overgeneralization, catastrophizing, and all-or-nothing thinking.
Hopefully, the above discussion will increase the chances that you will take up the challenge of mastering stress management skills. I can tell you that from my own experience it is possible to transform many old entrenched habits, which typically escalate stressful experiences, to new ones that leave me in a far more comfortable state of mind.
Many soon become cognitively convinced of this, and yet the next time they come in contact with such a snake their bodies still become as stressed as ever. Such individuals, with guided practice, and a little patience, do learn to become comfortable when they see nonpoisonous snakes.
I suggest the following format for such groups. Everyone in the group would come prepared having read the post that will be discussed for the week. After 5 minutes of greeting each other, take twenty minutes to have a group meditation. A simple form of meditation is described 