ADHD and Genetic Testing

Advertisement for a quick-dissolve, long-acting amphetamine from a psychiatry trade journal:  

Ah yes, "Designed With Patients in Mind."

I understand the difficulty that comes with a child that meets the criteria of ADHD and I don't want to dismiss out of hand, the pharmaceutical "solution" in such cases, but I think it's a good diagnosis to discuss in regards to genetic correlation tests, to address some of the larger implications.  The fact that we are talking about children makes it all the more important to get it right.

For starters, what I said to the authors of an ADHD study 15 years ago remains true {My letter here and the response here}:  No specific gene has been identified and consistently replicated that corresponds to ADHD, or ADD for that matter.  Like with many psychiatric disorders, that perception gets lost to the general public, scientists and psychiatrists.  Part of that is driven by the pharmaceutical industry, which continues to crank out amphetamine derivatives and other medications.  Part of it is a push from overwhelmed teachers and school systems that can't easily accommodate students in large classrooms who can't sit still for 8 hours a day the way the system is currently set up.  Part of it comes from psychiatrists looking for a quick and easy solution to an otherwise difficult problem.
However, I would also point out the role that science plays in this, in effecitively defining it as a genetic disorder.  Despite my point above that no specific gene has been definitively identified as contributing either in part or fully to the disorder, the endless cycle of genetic studies for ADHD (at least in the past, I haven't seen as many recently), usually of the GWAS variety, that purport to show a link for particular genes to the disorder contribute to the mindset that this is a largely genetic/neurological disorder, despite the fact that these studies never get replicated.  Often, these studies make it on the front page of mainstream newspapers, "Gene for ADHD Found," without ever being retracted when found not to have merit.  It creates a mindset, and this mindset is not innocuous.  Policies and solutions to problems are approached with the biases and perceptions of the policy makers (and the public at large).  If it is assumed that we have, essentially, a physical "disorder", then they will be less patient about looking for a non-chemical solution.
I hear a lot of scientists expressing concern about being perceived as eugenicists when discussing genetics and intelligence or mental illness.  Their concerns are understandable, but I think they should also ask themselves to what extent they are promoting ideas about a genetic basis for things when, in truth, there is no proven genetic link as yet.  It shows a certain bias, that isn't as far off of eugenic ideas as you might want to believe.  Many (not all, of course) of the overt eugenicists of the early part of last century, if you look at their lives, seemed to be very well-meaning people. 
Moreover, I don't know how many times I've seen other psychiatrists lay out the idea to patients and their families that ADHD and other psychiatric disorders are largely organic, with a significant genetic component and that they need to be treated with medication.  We are pretending to have more knowledge than we actually have.
To help shake off at least some of this attitude, I'd like anyone reading this to consider a child, we'll say a young girl, who lives in a world where the most important thing in that world is sports, and she has little or no interest in sports.  She sits in classes each day like, "Basic Hockey Strategy," "How To Swing a Baseball Bat," "Sportswriting," "Sports Literature," etc.  Can we imagine for a moment that this person might have a hard time sitting still in classes all day, might be quite disruptive and have difficulties focusing her attention, might act out frequently and perhaps even long to go to the principal's office to get out of class for awhile and engage in truancy out of a sense of boredom and disenfranchisement?  In such a situation, can we see where giving the person an amphetamine might allow them to stay focused in class more and improve her grades, and not get herself into as much trouble, without actually addressing the broader issue?  So, in that situation, do we say that she had a genetic disorder that caused her behavior, or even a genetic "disorder" that caused her to dislike sports and give her medication to treat that disorder?  I think that is the current mentality of our culture, in part driven by speculative science, and I don't see that it is taking us in a positive direction.  Nor do I agree with the premise.  I believe it is generally best to first look at the person and situation, before jumping to these easy and pat solutions.  I say this not only from a humanitarian perspective, but from a scientific one.  What if genes aren't the cause of these problems and all of our scientists are spending their time focused on a dead end?  Just consider the possibility that the science we are looking at is going in a wrong direction altogether.