Following are some remarks about a psychiatric concept known as DAMP (Deficits in Attention, Motor control, and Perception). This concept was conceived by Christopher Gillberg.
DAMP—Deficits in Attention, Motor control, and Perception—is a psychiatric concept formulated by Christopher Gillberg. DAMP is similar to another concept known as MBD (Minimal Brain Dysfunction), which was formulated in the 1960s. Both concepts are related to certain psychiatric conditions, such as hyperactivity.
The concept of MBD was strongly criticized by several researchers, especially Sir Michael Rutter (who is sometimes described as the “father of child psychology”), and this led to its abandonment in the 1980s. At the same time, research showed that something similar was needed. One alternative concept was ADHD (Attention-Deficit Hyperactivity Disorder). In the early 1980s, Gillberg proposed a different alternative: DAMP. (DAMP is essentially MBD without the etiological assumptions.)
The concept of DAMP met with considerable criticism. For example, Sir Michael Rutter compared the concept of DAMP with MBD thus: “Concept of DAMP is even more muddled and it similarly lacks both internal coherence and external discriminative validity … it has no demonstrated treatment or prognostic implications”; he concluded that the concept should be abandoned. Another example is the criticism of Per-Anders Rydelius, Professor of Child Psychiatry at the Karolinska Institute, who argued that the definition of DAMP was too vague: “the borderline between DAMP and conduct disorders [is] unclear … the borderline between DAMP and ADHD [is] unclear”; he concluded that “the concept is in need of revision”. And in 2000, Eva Kärfve, a sociologist at the University of Lund, published a book which argued that Gillberg's work on DAMP should be rejected.
Perhaps the strongest criticism of DAMP is that Gillberg and his co-workers in Gothenburg are almost the only people doing research on DAMP. Indeed, in a review of DAMP published by Gillberg in 2003, it was noted that there were only “about 50” research papers that had been published on DAMP and that the “vast majority of these have either originated in the author's own clinical and research setting or have been supervised and/or co-authored by him”. This is in contrast to ADHD, on which “several thousand papers” had been published. As far as clinical practice goes, DAMP had been primarily accepted only in Gillberg's native Sweden and in Denmark (and even in those countries acceptance had been mixed).
Gillberg ultimately revised his definition of DAMP, to make it more precise: DAMP became a subclass of ADHD. Criticism of DAMP, however, continued. For example, a research article by Edmund Sonuga-Barke, at the Centre for Research into Psychological Development in England, concluded that “the validity and utility of DAMP will remain unclear until stronger evidence of the special status of the overlap between its constituent disorders is provided”. In 2005, there was an hour-long program broadcast on Swedish TV, questioning why Sweden, essentially alone in the world, would accept the DAMP construct.
Andersson E. (2004), Debatten om DAMP: En kontroversstudie (University of Stockholm). [Synopsis of a conference, very critical of DAMP; in Swedish]
Bagge P. (5 July 2005), “Forskarstrid: DAMP ifrågasätts från fler än ett håll”, Sveriges Television. [Summary of televised show, including an interview with Sir Michael Rutter; in Swedish.]
Gallup R., Miller C.G., Elinder L.R., Brante T., Kärfve E., Josephson S. (July 2005), “Rapid Responses”, British Medical Journal. [Includes the quotation from Sir Michael Rutter.]
Gillberg C. (1986), “Attention deficit disorder: diagnosis, prevalence, management and outcome”, Pediatrician, 13: 108–118. [The first research paper to use the term “DAMP”, although the concept itself was formulated a few years earlier.]
Gillberg C. (2003), “Deficits in attention, motor control, and perception: a brief review”, Archives of Disease in Childhood, 88: 904–910. doi: 10.1136/adc.88.10.904.
Kärfve E. (2000), Hjärnspöken—DAMP och hotet mor folkhälsan [Idle Imaginings—DAMP and the threat to public health] (Stockholm: Brutus Östlings Bokförlag Symposion). [In Swedish.]
Rasmussen N.H. (November 2003), “Deficits in attention, motor control, and perception: a brief review”, Archives of Disease in Childhood eLetters. [Critical response to Gillberg's article in the journal earlier that year.]
Rydelius P.-A. (2000), “DAMP and MBD versus AD/HD and hyperkinetic disorders”, Acta Pædiatrica, 89: 266–268. doi: 10.1080/080352500750028375.
Sonuga-Barke E.J.S. (2003), “On the intersection between AD/HD and DCD: The DAMP hypothesis”, Child and Adolescent Mental Health, 8: 114–116.