When I met Sarah Mercer, 27, she was at the end of her tether. Her daughter Tia, 7, frequently launched savage attacks on her older sibling Paige, an even-tempered nine-year-old who gave little cause for offence. Tia “hated” her mother and said she would like to kill her. Well known in her neighbourhood as a “terror”, she exhibited many of the symptoms of attention deficit hyperactivity disorder (ADHD) — distracted concentration, inability to sit still, poor social skills — as well as an oppositional conduct disorder.
Increasingly, stimulant medications such as Ritalin are prescribed to such children — paradoxically, hyperactive children are made less so by “uppers” (amphetamine-based pills). Whereas only 6,000 British children took these drugs in 1994, 345,000 were doing so in 2003. The power of drug companies was shown by the decision to let children over 8 continue to be prescribed Prozac for depression, albeit accompanied by counselling.
Sarah was determined not to travel down the biochemical road. She tried the usual alternatives, from parenting classes to a supernanny-style “naughty” chair, to sending Tia for group play at the Child Mental Health Unit. None of them worked.
Conventional psychiatric wisdom is that they wouldn’t make much difference because Tia has a genetic disease. ADHD “is a common, highly heritable neurodevelopmental disorder”, according to Eric Taylor, Britain’s leading ADHD child psychiatrist. As we shall see, this assertion is a gross misrepresentation of the scientific evidence (indeed, America’s highly regarded National Institute of Health finds no evidence that ADHD is a biological brain disorder).
In listening to Tia’s history, a very plausible alternative to genes emerged for why she is so different from Paige. During the pregnancy with Tia, Sarah’s husband became increasingly angry, drunken and violent. Three months after the birth, driven into a depression for which she was given pills, Sarah finally made the decision to leave him. While it was a great relief to escape from such a troubled relationship, Sarah is in no doubt that when she was pregnant with Tia and during her first year, she was much less able to relate to her than to Paige, with whom she had bonded strongly.
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This is consistent with two important bodies of scientific literature that are gradually coming increasingly into the public eye. A large study of Danish mums recently showed that maternal anxiety and distress during pregnancy increases the risk of low birth weight because it causes high levels of cortisol, the fight-flight hormone, in offspring. The anxiety-inducing high cortisol levels are passed through the placenta to the foetus. This makes the child at greater risk of being jumpy and overexcitable, jammed in a state of permanent preparation to deal with threat. In several studies, the effect has been shown to endure long after the birth.
Boys whose mothers were emotionally troubled during late pregnancy were significantly more likely to have ADHD when followed up at 3, 5, 7 and 9. A study of 7,000 offspring of mothers who had been anxious in the third trimester were twice as likely to have ADHD. Tia’s story is also consistent with the second body of evidence: disturbed early relating between mother and baby can contribute to ADHD. Offspring of mothers who are measured as intrusive or overstimulating when the infant is six months old are more likely to have ADHD when aged 3 and 11.
A further strong clue that genes are not the key comes from studies of children who have been removed from severely maltreating parents. Those placed in institutions, where the care is liable to be impersonal and inconsistent, are at much higher risk of the illness than those taken into foster care with relatively nurturant, substitute parents. That quality of care is vital is also suggested by the fact that offspring of single parents — more likely be overstretched and harassed, as Sarah was — are three times more liable to have ADHD.
This evidence suggests that prenatal exposure to high cortisol levels creates a wired, overexcitable personality. Subsequently, if mother is not tuned into her infant or substitute care is poor, there may be a legacy of violent rage and attention-seeking. Apart from recommending that Tia cut out all sweets (see Sami Timimi’s book, Naughty Boys, for evidence that they can worsen ADHD), rather than pills to mask the symptoms, my advice to Sarah was to attempt a radical and newly validated solution.
In a study published this year of 102 badly behaved children — some with ADHD — parents had been taught a very intense hugging therapy. It entails treating them like a baby as a way of trying to meet those unmet early needs, creating attunement between parent and child at a very primitive level.
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Parents hugged the child face-to-face for between 20 and 90 consecutive minutes and, along with being given a great deal of additional advice, maintained this daily for a year. Assessed at the end of the study, nearly all the children (96 out of 102) were half as badly behaved as at the start. Since she had tried everything else, Sarah decided to give it a go. The next weekend she left Paige with her mother and spent 24 hours hugging for England, subsequently doing hug top-ups morning and evening. Only one week later, the results amazed me, as well as her. Tia had become much calmer, loving to her mother and less antagonistic to her sister. Three weeks later, the improvement had been sustained.
On its own, this improvement proves nothing about the role of genes in causing either ADHD or mental illness in general. More reliable are the growing numbers of senior figures from the psychiatric and genetic establishment who have recently begun to admit that the evidence from the Human Genome Project is confounding genetic explanation.
Using the map of our genes, molecular geneticists have been searching for specific genes that distinguish people more prone to par- ticular illnesses. Robert Plomin, the most important single researcher in the field of the genetic causes of mental illness, finds very little. While a single gene has been identified as causing 15 per cent of all cases of Alzheimer’s, this is the only illness for which a gene has been identified. There is no replicated evidence that schizophrenics, neurotics or depressives have different genes from people without these illnesses.
This was recently spelt out explicitly by Kenneth Kendler, a doyen of the American psychiatric establishment. He wrote that “the strong, clear, and direct causal relationship implied by the concept of ‘a gene for . . . two’ does not exist for psychiatric disorders. Although we may wish it to be true, we do not have and are not likely to ever discover ‘genes for’ psychiatric illness.”
For the time being, geneticists’ only support is studies of identical twins, and those are increasingly regarded as unreliable (see Jay Joseph’s The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes). Even if twin studies are accepted, their results suggest that genes explain only a modest amount — 30 per cent at most — of the vast majority of mental illness: minor depression, anxiety, personality disorders. What is more, a new body of research (see John Read’s Models of Madness) strongly suggests that at least half of schizophrenia, and possibly bipolar (mania and depression) disorders as well, are explained by abuse.
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Forty studies find that most psychiatric patients experienced sexual or physical abuse. Read has demonstrated to many of his peers’ satisfaction that the hallucinations of these patients are often a form of post-traumatic stress disorder, not a consequence of genes. But perhaps most interesting of all is a World Health Organisation study of representative samples in 13 nations. It reveals huge differences in rates of mental illness which are almost certainly not explained by genes.
Indeed, my analysis of these results (with Kate Pickering and Richard Wilkinson) shows that among developed nations, it is the size of inequality of income distribution and wealth of a nation that explains the differences: the richer and more unequal, the higher the illness rate.
The pressure to acknowledge environmental factors in ADHD is building. Plans to feed children fish oil daily suggests that our rulers’ attention is not wholly deficient — someone has finally noticed the vast body of evidence linking ADHD to diet. The child psychiatric establishment and the BMA — too often the mouthpieces of a drug industry to which they have close financial links — will present the results of a report that pays lip service to this evidence. But do not expect any radical changes. Parents will still have to use their own initiative to deal with severe problems in their children.
Oliver James is the author of They F*** You Up: How to Survive Family Life. His new book, Affluenza: How to Be Successful and Stay Sane, will be published in January