原文標題:ADHD as Cargo Cult Science
原文來源:https://www.madinamerica.com/2021/11/adhd-as-cargo-cult-science/
By Sheelah Mills – November 20, 2021
作者：Sheelah Mills – 2021年11月20日
I began seriously researching ADHD in 2010 with the purchase of Barkley’s Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Positive reviews indicated that this would be a worthy source of information for my fourth-year psychology dissertation. At the end of Chapter 1, there was a copy of an International Consensus Statement on ADHD, which stated:
我在2010年開始認真研究ADHD（注意力缺陷多動障礙），並購買了巴克利的《注意力缺陷多動障礙：診斷與治療手冊》。正面的評論顯示這將是我大四心理學論文的重要資料來源。在第一章的結尾，附有一份關於ADHD的國際共識聲明，聲明指出：
Occasional coverage of the disorder casts the story in the form with evenly matched competitors. The views of a handful of nonexpert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views have equal merit. Such attempts at balance give the public the impression that there is substantial disagreement over whether ADHD is a real medical condition. In fact, there is no such disagreement—at least no more so than there is over whether smoking causes cancer, for example, or whether a virus causes HIV/AIDS.
有時候，關於這種障礙的報導會將故事呈現為勢均力敵的競爭對手。少數非專業醫生認為ADHD不存在的觀點，與主流科學界認為ADHD存在的觀點形成對比，好像這兩種觀點同樣具有價值。這種為了平衡的嘗試會讓公眾產生一種錯覺，認為關於ADHD是否是一種真正的醫學狀況存在重大分歧。事實上，並不存在這樣的分歧——至少不會比關於吸煙是否會致癌，或病毒是否會引發HIV/AIDS的爭論更多。
Somewhat cowed by the tone and the status of the 86 signatories, I continued with Barkley’s voluminous account of all things related to ADHD.
However, halfway through Chapter 2, Barkley once again criticised “nonexpert professionals”, before concluding:
Therefore, any claims that ADHD is a myth reflect either a stunning level of scientific illiteracy or outright attempts to misrepresent the science of ADHD so as to mislead the public with propaganda.
Throughout this section Barkley repeatedly referenced an article by Sami Timimi. Curious about what might constitute “scientific illiteracy”, I sourced the document to find Timimi was not the sole author; there were 33 co-endorsers, who were anything but “nonexpert”, judging by their qualifications, academic standing, and publications.1
在86位簽署者的語氣和地位有些令人畏懼的情況下，我繼續閱讀巴克利的這本關於ADHD的龐大著作。
然而，在第二章讀到一半時，巴克利再次批評了“非專業人士”，並總結道：
因此，任何聲稱ADHD是虛構的說法，不是反映出驚人的科學素養不足，就是蓄意曲解ADHD的科學知識，試圖用宣傳來誤導公眾。
在這一節中，巴克利反覆引用了一篇由Sami Timimi撰寫的文章。出於對“科學素養不足”具體是什麼的好奇，我找到了這篇文獻，發現Timimi並非唯一的作者；該文章有33位聯合簽署者，根據他們的資歷、學術地位和出版作品來看，這些人根本不算是“非專家”。
(And they are far from the only experts who have critiqued the diagnosis of ADHD. In more recent years, Allen Frances—chair of the DSM-IV task force—has levied extensive critique against the diagnosis, as had Keith Conners—considered the “father of ADHD” and namesake of the Conners Comprehensive Behavior Rating Scale.)
（而且他們遠不是唯一批評ADHD診斷的專家。近年來，DSM-IV任務小組主席艾倫·弗朗西斯（Allen Frances）對ADHD診斷提出了廣泛的批評，被稱為“ADHD之父”並以其命名的康納斯綜合行為評估量表的基思·康納斯（Keith Conners）也對此提出了批評。）
Furthermore, Timimi’s article was a critique of the Consensus Statement, something Barkley did not acknowledge. Critique is a legitimate and important part of the scientific process. Additionally, Barkley’s use of the word myth was misleading, as it suggested Timimi et al. took the extreme position of stating ADHD did not exist. This was not the case.
此外，Timimi的文章是對《共識聲明》的批評，這一點巴克利並沒有提到。批評是科學過程中合法且重要的一部分。此外，巴克利使用“虛構”一詞具有誤導性，因為這暗示Timimi等人採取了極端立場，聲稱ADHD不存在。但事實並非如此。
The points they raised, and the manner in which these contrasted with Barkley et al.’s, were the impetus for my research. The focus of my PhD has been to identify the processes by which ADHD has come to be understood as a medical condition. My aim has been to establish whether these processes are sufficiently robust to withstand criticism without resorting to displays of hubris.
他們提出的觀點以及這些觀點與巴克利等人的對比方式，成為了我研究的動力。我博士研究的重點是確定ADHD是如何被理解為一種醫學狀況的過程。我的目標是確定這些過程是否足夠強大，可以承受批評，而不至於顯得自負。
As publications about ADHD are now in their tens of thousands, finding a way to establish the veracity of Barkley et al.’s claims was somewhat problematic. However, the journal article with the highest citation count on the database Scopus is an article by Barkley called “Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD.” (As of November 9, 2021 it has 4,772 citations with 263 added in 2021, by subject 2,749 are categorised as psychology, 2,340 medicine, and 1,240 neuroscience).
由於關於ADHD的出版物已達到數萬篇，找到驗證巴克利等人觀點真實性的方法變得有些棘手。然而，在Scopus數據庫中引用次數最高的文章是巴克利的一篇文章，題為《行為抑制、持續注意力與執行功能：構建ADHD的統一理論》。截至2021年11月9日，這篇文章有4,772次引用，其中263次是在2021年新增的。根據學科分類，2,749次屬於心理學，2,340次屬於醫學，1,240次屬於神經科學。
As Barkley’s theory has had a strong influence on research into ADHD, evaluation of this theory has been a major part of my inquiry. What I found was that Barkley’s theory was akin to what Richard Feynman called “Cargo Cult Science,” only more misleading and dangerous.
由於巴克利的理論對ADHD研究有著強大的影響，評估這一理論成為了我研究的重要部分。我發現巴克利的理論類似於理查德·費曼所說的“貨物崇拜科學”，只是更具誤導性和危險性。
Feynman, the famous physicist, used the term “Cargo Cult Science” in his 1974 commencement address to students at the California Institute of Technology (Caltech). He described how, in the South Seas during the Second World War, a group of unnamed islanders had watched planes land full of good materials. After the war ended, the islanders wanted the planes to return:
著名物理學家費曼在1974年於加州理工學院（Caltech）畢業典禮上對學生們使用了“貨物崇拜科學”這個術語。他描述了二戰期間，南太平洋上的一群島民目睹飛機降落，滿載著各種物資。戰爭結束後，這些島民希望飛機能再次返回：
So they’ve arranged to make things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas—he’s the controller—and they wait for the airplanes to land. They are doing everything right. The form is perfect. It looks exactly the way it looked before. But it doesn’t work. No airplanes land. So I call these things Cargo Cult Science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.
於是他們安排了建造跑道，在跑道兩側點火，建了一個木屋，讓一個人坐在裡面，頭上戴著兩塊木頭做的“耳機”，並在竹子桿子上插上像天線一樣的東西——這個人是“控制員”，他們等待飛機降落。他們做的一切都很正確，形式也很完美，看起來跟以前一模一樣。但它不起作用，沒有飛機降落。因此，我稱這些東西為“貨物崇拜科學”，因為它們遵循了所有表面上的科學調查規範和形式，但缺少了某些關鍵的東西，因為飛機沒有降落。
Feynman argued that Cargo Cult Science involves cherry-picking evidence to support an assumed conclusion, ignoring contradictory evidence, and giving the appearance of science while failing to actually follow the scientific method.
The explanation in Barkley’s highly-cited article was lengthy and confusing, especially when it led into a conceptual model of “executive, self-directed actions”. Key to the entire work was Barkley’s statement that “poor behavioral inhibition is specified as the central deficiency in ADHD”. He claimed this influences the “executive” actions, also referred to as “functions” in his model. However, Barkley did not give a precise definition for “behavioural inhibition.”
Based on the articles that Barkley cited to support his theory, I concluded that his hypothesised deficiency is what others refer to as impulsivity. Impulsivity is considered a major symptom of ADHD, but Barkley seemed to be saying that ADHD, including impulsivity, is caused by being impulsive—making his argument circular.
Following this, I evaluated the evidence Barkley provided for this proposal. This evidence relied almost entirely on experiments from the school of cognitive psychology—many of which attempted to ascertain the validity of ADHD by timing children’s responses to meaningless tasks within a laboratory setting.
費曼認為，貨物崇拜科學（Cargo Cult Science）涉及挑選支持預設結論的證據，忽視相互矛盾的證據，並在表面上看起來像是科學，實際上卻沒有遵循真正的科學方法。
巴克利那篇備受引用的文章中的解釋冗長且令人困惑，特別是在進入“執行、自我導向行為”的概念模型時。整篇文章的關鍵在於巴克利的說法：“行為抑制不足被指定為ADHD的核心缺陷。”他聲稱這會影響“執行”行為，在他的模型中也被稱為“功能”。然而，巴克利並沒有對“行為抑制”給出精確的定義。
根據巴克利引用的支持其理論的文章，我得出結論，他假設的這種缺陷是其他人所指的“衝動性”。衝動性被認為是ADHD的一個主要症狀，但巴克利似乎在說，ADHD，包括衝動性，是由衝動引起的——這使得他的論點變得循環論證。
接著，我評估了巴克利為此提出的證據。這些證據幾乎全部依賴於認知心理學學派的實驗——許多實驗試圖通過測量兒童在實驗室中對無意義任務的反應時間來驗證ADHD的有效性。
The main authority Barkley cited in his argument that ADHD was due poor behavioural inhibition was a 1977 essay by the late Jacob Bronowski. Whilst Bronowski may well have been held in regard for his intellect, not least for his presentation of a British documentary series The Ascent of Man, this usage by Barkley is somewhat curious.
巴克利在他關於ADHD源於行為抑制不足的論點中，主要引用了一篇1977年已故Jacob Bronowski的文章。雖然Bronowski以其智慧備受推崇，尤其是他主持的英國紀錄片系列《人類的崛起》，但巴克利對這篇文章的引用有些令人感到奇怪。
All the more so, when the point of Bronowski’s essay was to explain the evolutionary differences between human language and animal communication. Bronowski admitted that he was writing as an amateur, but he hoped that what he had to say would throw light on his special interests “namely the language of science, and the language of poetry”.
更特別的是，Bronowski的文章主旨在於解釋人類語言和動物交流之間的進化差異。Bronowski承認他是以業餘身份撰寫此文，但他希望他的見解能夠闡明他感興趣的領域，“即科學語言和詩歌語言”。
Bronowski proposed that “the central and formative feature in the evolution of human language” is “a delay between the arrival of the stimulus and the utterance of the message it has provoked”. Bronowski expanded on four consequences of this delay; these he named separation of affect, prolongation, internalization and reconstitution. But throughout, his main point was to explain “the difference between the way human beings can use language and the way animals do”.
Bronowski提出“人類語言進化的核心特徵”是“刺激的到來與所引發的信息表達之間的延遲”。他詳細闡述了這種延遲的四個後果，分別命名為情感分離、延長、內化和重構。但整篇文章的主要目的是解釋“人類使用語言的方式與動物使用語言的方式之間的差異”。
Bronowski’s essay was published posthumously in its original form; it was neither edited nor peer reviewed, hence its accuracy was never debated. But Barkley’s idea of “deficient behavioural inhibition” is based on Bronowski’s hypothesised delay. Whereas Bronowski proposed this delay was the point in evolutionary history that humans and animals separated, in Barkley’s theory this is the point at which those with ADHD versus those without differ. Bronowski’s “consequences” led to different evolutionary pathways dating back possibly two million years.
Bronowski的文章在他去世後以原始形式發表，沒有經過編輯或同行評審，因此其準確性從未受到討論。但巴克利的“行為抑制不足”理論是基於Bronowski假設的延遲。Bronowski認為這種延遲是人類和動物在進化歷史上分化的關鍵點，而在巴克利的理論中，這是ADHD患者與非ADHD患者之間的差異點。Bronowski的“後果”導致了可能追溯到兩百萬年前的不同進化路徑。
For Barkley, the consequence of this delay was one which impacted executive functioning, a term Barkley attributed to Denckla, among others. Denckla stated that it was generally agreed that executive functions referred to “mental control processes”. Barkley used this notion to devise four categories, supposedly modelled on the four terms used by Bronowski. Barkley retained Bronowski’s term reconstitution but renamed the other categories as working memory, self-regulation of affect/motivation/arousal and internalization of speech. Then, under each heading, Barkley listed various behaviours, 22 in total, which he deemed could be improved or normalised by “amelioration of the inhibitory deficit”.
對巴克利而言，這種延遲的後果影響了執行功能，巴克利將此術語歸功於Denckla等人。Denckla指出，一般認為執行功能是指“心理控制過程”。巴克利利用這一概念設計了四個類別，據稱是以Bronowski使用的四個術語為模型。巴克利保留了Bronowski的“重構”一詞，但將其他類別重新命名為工作記憶、情感/動機/喚醒的自我調節和語言的內化。然後，在每個標題下，巴克利列出了各種行為，共22項，他認為這些行為可以通過“改善抑制缺陷”得到改善或正常化。
He didn’t suggest any specific form of intervention, but he later identified an unresolved issue worthy of future research: “the degree to which medications differently affect each of these domains of executive function”.
他並沒有提出具體的干預方式，但後來指出了一個值得未來研究的未解決問題：“藥物對這些執行功能領域的不同影響程度”。
Although Barkley’s model bears little resemblance to Bronowski’s ideas, Barkley stated that “Bronowski attributed these four executive functions to the prefrontal lobes”. In fact, Bronowski made no mention of the functions being localised in the frontal lobes, or indeed anywhere in the brain. It appears the connection with the frontal lobe comes from Fuster’s theory of prefrontal function, which Barkley claimed to have “much in common” with Bronowski’s work. For this reason, he included Fuster’s theory of Neural Mechanisms Underlying Behavioral Structure in his executive function model.
雖然巴克利的模型與Bronowski的思想幾乎沒有相似之處，但巴克利聲稱“Bronowski將這四個執行功能歸因於額葉”。事實上，Bronowski並沒有提到這些功能位於額葉，甚至沒有提到大腦的任何部位。看來這種與額葉的聯繫來自於Fuster的前額葉功能理論，巴克利聲稱該理論與Bronowski的研究“有很多共同點”。因此，他將Fuster的“行為結構背後的神經機制”理論納入了他的執行功能模型。
Fuster’s theory first appeared in his book The Prefrontal Cortex: Anatomy, Physiology, and Neuropsychology of the Frontal Lobe. Barkley referred repeatedly to “behavioural structures”, but otherwise ignored the large portion of Fuster’s work that failed to support his approach. As to the commonality between the two sources, as noted, Bronowski did not mention the prefrontal cortex. Instead, he attributed his hypothesised delay to a “biochemical peculiarity”, one where humans lost the ability to make the enzyme uricase.
Fuster的理論首次出現在他的書《前額葉皮層：解剖學、生理學與額葉的神經心理學》中。巴克利反覆提到“行為結構”，但忽視了Fuster的大部分研究，這些部分並不支持他的觀點。至於兩者之間的共同點，如前所述，Bronowski並未提及前額葉皮層。相反，他將假設的延遲歸因於一種“生化特性”，即人類失去了製造尿酸酶的能力。
Furthermore, this delay was described by Bronowski as a “linguistic mechanism…an inherent delay in human response”. By contrast, Fuster stated that “automatic, or instinctual series of acts, however complex, does not qualify and is not within the purview of the prefrontal cortex”.
此外，Bronowski將這種延遲描述為一種“語言機制……人類反應中的固有延遲”。相比之下，Fuster指出，“自動或本能的行為序列，無論多麼複雜，都不屬於前額葉皮層的範疇”。
But most worryingly, this particular theory, based on flimsy cognitive psychology research, a curious use of Bronowski’s essay, and a bogus link to the prefrontal cortex, has been cited by some in the medical community in the context of validating ADHD as a condition relating to frontal cortex abnormalities—notably, Stephen Faraone and Joseph Biederman in their 1998 coining of the phrase “frontalsubcortical” abnormalities. In The Lancet, they claimed that the frontalsubcortical hypothesis had been confirmed.
但最令人擔憂的是，這一理論基於脆弱的認知心理學研究、對Bronowski文章的奇怪引用以及對前額葉皮層的虛假聯繫，已被醫學界一些人士引用來驗證ADHD與額葉皮層異常有關的假說，特別是1998年Stephen Faraone和Joseph Biederman創造的“額葉-皮質下異常”一詞。他們在《柳葉刀》上聲稱，額葉-皮質下假說已被證實。
Likewise, albeit without direct reference to Barkley, Faraone argued in 2005 that ADHD was a valid condition due to frontalsubcortical abnormalities. Not long afterwards, Halperin and Schulz noted that theories such as Barkley’s had led to numerous inconsistencies in the literature, to the extent that it was impossible to identify the precise nature of ADHD pathophysiology. But, rather than question the notion of abnormal neurological functioning, the authors proposed that a different brain area might be defective.
同樣地，儘管沒有直接引用巴克利的研究，Faraone在2005年主張，由於額葉-皮質下異常，ADHD是一種有效的病症。不久之後，Halperin和Schulz指出，像巴克利這樣的理論導致了文獻中許多不一致之處，甚至難以確定ADHD病理生理學的精確本質。然而，作者並沒有質疑神經功能異常的概念，而是提出可能是大腦的另一個區域存在缺陷。
On this basis, “the largest dataset to date” was pooled by Hoogman et al., and supposedly found evidence of brain abnormalities. However, this research was criticized so roundly that Lancet Psychiatry devoted an entire issue to rebuttals by researchers as distinguished, again, as Allen Frances and Keith Conners, who all argued that Hoogman et al.’s own data did not support their claims.
基於此，Hoogman等人彙集了“迄今為止最大數據集”，並聲稱發現了大腦異常的證據。然而，這項研究受到了廣泛的批評，柳葉刀精神病學甚至將整期雜誌專門用來刊登回應文章，由包括艾倫·弗朗西斯（Allen Frances）和基思·康納斯（Keith Conners）等著名研究人員撰寫，他們一致認為Hoogman等人的數據並不支持其論點。
In the Hoogman et al. study, the list of financial conflicts of interests tying the researchers, including Biederman and Faraone, to the pharmaceutical industry, is extensive. This is problematic because it has been found that researchers receiving money from industry biases the results; the greater the bias, the less likely research findings are to be true. John Ioannidis explained this in an article titled “Why Most Published Research Findings Are False”. He presented a formula to support his hypothesis, then outlined the many forms that bias can take.
在Hoogman等人的研究中，列出的與製藥行業有財務利益衝突的研究人員名單非常龐大，這些人包括Biederman和Faraone。這是一個問題，因為已經發現，接受來自行業資金的研究人員，其研究結果往往會受到偏見的影響；偏見越大，研究結果越不可能是真實的。John Ioannidis在他的一篇名為《為什麼大多數發表的研究結果是錯誤的》文章中解釋了這一點。他提出了一個公式來支持他的假設，並且列出了偏見可能出現的多種形式。
Cosgrove and Wheeler specifically examined conflicts of interest in psychiatry, and concluded that organised psychiatry’s dependence on drug firm funding had distorted the science. In particular, they found that the evidence bases upon which “accurate diagnosis and sound treatment depend” had been corrupted.
This is not altogether surprising, since industry funds research with the expectation of financial gains. Biederman and Faraone made this commitment to Johnson and Johnson back in 2002 when they received funding for the Center for Pediatric Psychopathology at Massachusetts General Hospital, the largest teaching hospital of Harvard Medical School. Part of their brief was to “move forward the commercial goals of J&J”.
Cosgrove和Wheeler專門研究了精神病學中的利益衝突，並得出結論：組織化的精神病學對製藥公司資金的依賴已經扭曲了科學。他們特別發現，“準確診斷和合理治療所依賴的證據基礎”已經被腐化。
這並不完全令人驚訝，因為行業資助研究是期望獲得財務回報。Biederman和Faraone早在2002年就向強生公司做出了這樣的承諾，當時他們為哈佛醫學院最大的教學醫院——麻薩諸塞州總醫院的小兒精神病理學中心獲得了資金。他們的部分任務是“推進強生公司的商業目標”。
They also acknowledged that it was equally important to demonstrate the validity of childhood disorders as brain disorders. They stated that without data from genetic and brain imaging studies, “many clinicians question the wisdom of aggressively treating children with medications, especially those like neuroleptics, which expose children to potentially serious adverse events”.
他們還承認，證明兒童疾病作為腦部疾病的有效性同樣重要。他們表示，如果沒有來自基因和腦成像研究的數據，“許多臨床醫生會質疑用藥物積極治療兒童的合理性，尤其是像神經抑制劑這樣的藥物，可能會讓兒童暴露於嚴重的不良事件中”。
Since their first citation of Barkley’s theory, with its false connection to prefrontal abnormalities, and with their continuing insistence that ADHD is a valid brain disorder, diagnoses and prescribing rates have sky-rocketed worldwide, and numerous new medications have entered the field.
自從他們首次引用巴克利的理論，並錯誤地將其與前額葉異常聯繫起來，再加上他們不斷堅持ADHD是一種有效的腦部疾病，全球的診斷和處方率已經大幅上升，許多新的藥物也紛紛進入這一領域。
But are we any the wiser, and are children diagnosed as “having” ADHD benefitting from current interventions? ADHD is now a worldwide phenomenon with large volumes of data available. Many of these are presented in a recent publication by Faraone et al. in what they claim to be an update of Barkley et al.’s International Consensus Statement. Space does not allow for a discussion of their “cataloguing of important scientific discoveries from the last twenty years”; but under the heading of “What we have learned from studying the brains of people with ADHD”, they reported that differences “are typically small and…are not useful for diagnosing the disorder”.
但我們是否變得更加明智了？那些被診斷為“患有”ADHD的兒童是否從現行的干預措施中受益？ADHD現已成為全球現象，有大量的數據可供使用。這些數據中的許多內容在Faraone等人的一篇最新發表的文章中有所呈現，他們聲稱這是巴克利等人的國際共識聲明的更新版本。由於篇幅所限，無法討論他們所謂的“過去二十年來重要科學發現的編目”，但在“我們從研究ADHD患者的大腦中學到什麼”的標題下，他們報告說，差異“通常很小……並且無助於診斷該疾病”。
Meaning, as the researchers critiquing Hoogman et al. emphasized, there is no evidence of any structural abnormality, prefrontal or otherwise, in ADHD. The airplanes have not landed, nor are they likely to.
這意味著，正如批評Hoogman等人研究的學者所強調的，並沒有任何證據顯示ADHD存在結構異常，無論是前額葉還是其他區域。飛機沒有降落，也不太可能降落。
When Timimi et al. responded to the International Consensus Statement on ADHD, they argued:
當Timimi等人回應ADHD國際共識聲明時，他們提出了以下論點：
Not only is it completely counter to the spirit and practice of science to cease questioning the validity of ADHD as proposed by the consensus statement, there is an ethical and moral responsibility to do so. History teaches us again and again that one generation’s most cherished therapeutic ideas and practices, especially when applied on the powerless, are repudiated by the next, but not without leaving countless victims in their wake.
停止質疑共識聲明中提出的ADHD的有效性，不僅完全違背了科學的精神和實踐，還有一種倫理和道德責任要求繼續這樣做。歷史一次次告訴我們，一代人最珍視的治療理念和做法，尤其是在對無權者的應用中，會被下一代所否定，但這並非不會留下無數的受害者。
The data are now accruing to vindicate the stand taken by Timimi et al., including evidence on the poor long-term efficacy of stimulants. A population-based cohort study by Fleming et al. analysed the health and educational data of 766,244 children attending Scottish primary, secondary, and special schools between 2009 and 2013. They concluded that:
現在，越來越多的數據證明了Timimi等人所持立場的正確性，包括有關興奮劑長期療效差的證據。Fleming等人進行了一項基於人群的隊列研究，分析了2009年至2013年間蘇格蘭小學、中學和特殊學校766,244名兒童的健康和教育數據。他們得出結論：
The 7413 children receiving medication for attention-deficit/hyperactivity disorder had worse education outcomes (unauthorized absence, exclusion, special educational need, lower academic attainment, left school earlier, and higher unemployment) and health outcomes (hospitalizations overall and for injury).
7413名接受注意力缺陷/多動障礙藥物治療的兒童在教育方面的結果更差（未經授權的缺席、被排除在外、特殊教育需求、學業成就較低、提前輟學以及更高的失業率），並且在健康方面的結果也更差（整體住院率和因傷住院率較高）。
Even the NIMH’s MTA study—the seminal study of stimulant use, whose 1999 short-term outcomes have been used to support stimulant prescribing for 20 years—has confirmed, in every long-term publication, that taking stimulant drugs leads to worse outcomes, not better. This includes the three-year follow-up, the six-to-eight year follow-up, and the 16-year follow-up.
即使是美國國家心理健康研究所（NIMH）的MTA研究——這是關於興奮劑使用的開創性研究，其1999年的短期結果已被用來支持興奮劑處方長達20年——在每一項長期隨訪研究中都證實，服用興奮劑藥物導致的結果更糟，而不是更好。這包括三年的隨訪、六至八年的隨訪，以及16年的隨訪。
These outcomes are all the more concerning when considering that the youngest kids in a classroom are far more likely to be given a diagnosis of “ADHD” and medicated (when it’s likely just an age/maturity gap)—a finding that has been corroborated over and over again in numerous countries.
這些結果更令人擔憂的是，當考慮到班級裡年齡最小的孩子更有可能被診斷為“ADHD”並接受藥物治療時（實際上可能只是年齡/成熟度的差異）——這一發現已在多個國家多次得到證實。
Added to these concerns is the lack of knowledge about how the medications affect the developing brain. This was discussed in an article by Stern et al., where they proposed that early treatment with stimulants might actually worsen ADHD symptoms. They attributed this to “neuronal imprinting”—in which exposure to a drug can influence the functioning of the brain even when the drug is no longer present.
這些擔憂中還包括對藥物如何影響發展中大腦的知識不足。Stern等人在一篇文章中討論了這個問題，並提出早期使用興奮劑治療可能實際上會加重ADHD症狀。他們將這歸因於“神經元印記”，即藥物暴露後，即使藥物不再存在，仍會影響大腦的功能。
Stern et al. argued that neuronal imprinting altered behavior, including the way individuals responded to stimulation and to drugs. Based on evidence from animal and human studies, they proposed that, for some, stimulants might contribute to ADHD turning into a chronic lifetime disorder. Interestingly, although Barkley has proposed that the locale for his hypothesised defect is the prefrontal cortex, the word “neuron” only appears in his lengthy article once.
Stern等人認為，神經元印記改變了行為，包括個體對刺激和藥物的反應方式。基於動物和人類研究的證據，他們提出，對某些人來說，興奮劑可能導致ADHD變成一種終身的慢性疾病。有趣的是，儘管巴克利假設的缺陷位置在前額葉皮層，但在他冗長的文章中，“神經元”一詞僅出現了一次。
The point of Feynman’s address and his tale about “Cargo Cult Science” was that:
費曼演講中的重點及他關於“貨物崇拜科學”的故事是：
We’ve learned from experience that truth will out. Other experimenters will repeat your experiments and find out whether you were wrong or right. Nature’s phenomena will agree or they will disagree with your theory. And, although you may gain some temporary fame or excitement, you will not gain a reputation as a scientist if you haven’t tried to be very careful in this kind of work. And it’s this type of integrity, this kind of care not to fool yourself, that is missing to a large extent in much research into Cargo Cult Science.
我們從經驗中學到，真相終將揭示出來。其他實驗者會重複你的實驗，並發現你是錯還是對。自然現象要麼支持，要麼反對你的理論。儘管你可能會獲得一些短暫的名聲或興奮，但如果你在這類工作中沒有非常謹慎，你將不會獲得科學家的聲譽。而正是這種誠信，這種不欺騙自己的謹慎態度，在許多“貨物崇拜科學”的研究中，往往缺乏。
Feynman was optimistic about the self-correcting processes of science, but he probably never envisioned a situation where the commercial interests of multiple pharmaceutical companies were prioritised to the extent they are now. Faraone et al. wrote that the worldwide economic burden of ADHD is in the hundreds of billions of dollars—a “burden” which largely goes to the pharmaceutical industry as “profit.”
費曼對科學的自我糾正過程持樂觀態度，但他可能從未預見到如今多家製藥公司的商業利益被如此優先考慮的局面。Faraone等人寫道，ADHD在全球範圍內的經濟負擔高達數千億美元——這個“負擔”主要作為“利潤”流向了製藥行業。
Whilst key “experts” would have us believe this is due to some sort of frontalsubcortical abnormality, the alternative explanation is that the burden is due to the creation of a false narrative, intended to counteract those questioning what Biederman and Faraone called “the wisdom of aggressively treating children with medications, especially those like neuroleptics, which expose children to potentially serious adverse events”.
儘管一些主要的“專家”讓我們相信這是由於某種額葉-皮質下異常所致，但另一種解釋是，這一負擔是由於一個虛假的敘述被構建出來，旨在抵消那些質疑Biederman和Faraone所謂“積極用藥治療兒童的智慧，特別是像神經抑制劑這樣可能讓兒童面臨潛在嚴重不良事件的藥物”的人。
Acknowledgement: I would like to thank my supervisors, Professor Jon Jureidini and Dr. Melissa Raven, for feedback and assistance with this blog.
Acknowledgement:
我想感謝我的指導老師，Jon Jureidini教授和Melissa Raven博士，對此博客的反饋與協助。
腳註：
Sheelah MillsAn earlier career in primary education is behind Sheelah’s research on ADHD. Beginning with degree in psychology, she found more questions than answers. Nevertheless, it led to enrolment in a PhD, which she is completing as part of the Critical and Ethical Mental Health (CEMH) team at the Robinson Research Institute, University of Adelaide, Australia.
Sheelah Mills
Sheelah的ADHD研究源於她早期在初等教育的職業生涯。從心理學學位開始，她發現了比答案更多的問題。然而，這些問題促使她報讀了博士學位，目前她正在澳大利亞阿德萊德大學的羅賓遜研究所，作為批判與倫理心理健康（CEMH）團隊的一員，完成她的博士研究。