Fashionable diagnosis - ADHD etc

[lawrocket 3]

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I just wonder how much of it is caused by improper diet and lifestyle.

Yeah, that was the thinking in the 1970's - to eliminate red food dyes and other sugars. They found out it didn't work.

Back when I was diagnosed with it, I had tests performed over the period of a month. Back then, ADHD was a "rule out" diagnosis - everything else was ruled out.

The most stunning things that my neurologist pointed out were my very high threshhold for pain, and my EEG. My waking EEG was similar to that of a sleeping person. My sleeping EEG was similar to that of a person in a coma.

Ever know any bedwetters? There is a definite corrolation. Here's why - when a sleeping person might as well be in a coma, things like urinary urgency do not tend to wake that person up, nor does urinating. Only the coldness that results after a couple of minutes provides a shock to the system that wakes the kid up.

Chemically and activity-wise, our brains are usually set too low. Picture it like a car engine with the flow at idle set too low. If the car's idle is set too low, the driver has to keep throttling the engine to keep it from stalling and thus resulting in a far more active engine because the driver has to throttle it up so much. But if the idle is adjusted by adding more fuel, there is no need to rev up the engine and it runs more smoothly.

For those of you who always wondered, this explains why stimulants actually calm people like me down when they would leave an ordinary person wired. It is also why we with ADHD avoid the mundane - it does not provide enough stimulation to keep the brain working. Thus, we are constantly seeking sensory input.

I do not expect anyone who has not been afflicted with ADHD or been in a close relationship with an ADHD sufferer to understand it. It's like expecting a whuffo to understand why we skydive or a virgin to understand sex - it cannot be explained to or understood by those who have not experienced it, and even then, each person's understanding is different.

The hard thing for me to deal with is the stigma that is associated with it. I have told few in my profession about it, for I do not wish for them to think I will use it as a crutch.

In a sense, I suffer silently with it, unless I am around other ADHD sufferers. We can smell each other out. The behavioral patterns and idiosyncracies that we see in others that match our own are a sign that we can recognize. And the two or three otherwise quiet and non-obtrusive people who will be somewhat non-social because we do not want to embarrass ourselves will be off to one side gabbing and laughing and hooting and hollering because we understand each other while the rest of the room acknowledges that those people in the corner are pretty fucking weird.

My wife is hotter than your wife.

[Andy9o8 0]

Great post, and spot on. Too bad it won't educate the general public.

[Shotgun 1]

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Most ADD/ADHD diagnosis are based almost purely on natural observation by UNTRAINED persons (parents and teachers).

A diagnosis made by parents and teachers is not going to have much significance since they cannot prescribe medications (unless they choose to treat the problem without medications, which might be a good thing). Any real diagnosis is made by a trained health care provider, but there is still a lack of objective evidence in making the diagnosis. This seems to be the current problem with diagnosing any kind of mental illness, due to our lack of technology and our minimal understanding of how the brain works. (But hey, at least we're beyond feeling the bumps on our heads to explain personality problems.)

[Andy9o8 0]

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there is still a lack of objective evidence in making the diagnosis.

I understand what you're trying to say, but it's not entirely correct. More accurately put, ADD/ADHD is generally a differential diagnosis – a process of elimination to rule out other potential causes of the cluster of symptoms – much the same way that Parkinson's disease and Alzheimer's disease are generally diagnosed differentially. In each case, some of the indicia are subjective, and other indicia are objective.

[nerdgirl 0]

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In research, you MIGHT be able to get PET or fMRI testing for ADD/ADHD tho good luck getting it approved. I may very well be wrong, but I have NEVER heard of those tests being done for a diagnosis.

Cudlo -

You are correct that PET and fMRI are rarely done for diagnosis, which was what I wrote.

There's an extensive literature showing the changes in neurotransmitter activity (e.g., dopamine, calcium channel activity).

A few examples from the secondary literature:
-- http://www.medscape.com/viewarticle/457770
-- http://pn.psychiatryonline.org/cgi/content/full/36/18/18
-- http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=205810

Search "adhd" and "pet" or "fmri" on PubMed for the technical literature, e.g., http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&db=PubMed&term=dopamine+pet+adhd&tool=QuerySuggestion

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Most ADD/ADHD diagnosis are based almost purely on natural observation by UNTRAINED persons (parents and teachers).

I think that you and I have different definitions of diagnosis.
As far as I am aware, untrained individuals pretty commonly are the first observers of symptoms, e.g., coughing of bronchitis, flu-like symptoms, pain of a broken leg. A diagnosis is done by somone who is supposed to have some advanced training.

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In 60%+ of cases the doc doesn't even look at school records.

I'm not particularly skeptical that your figure is generally in the correct range, would like to see some data before I would cite it, however. Your statement speaks to issues of the current state of medical care in which doctor-patient time is minimized not to whether something has a nuerochemical origin or is ascribed pejoratively to parents wanting better bahaved kids & a sign of lack of perceived standard of self-responsibility.

I would prefer there be some standardized method/scale, however rough it might be, as a first attempt to provide indicators. That's one reason why we have thermometers - "cold" to someone in Miami in May is very different that "cold" to someone in Siberia in January. "32F" is provides a standard reference.

I am sympathetic to many of the problems that you noted w/r/t trying to apply one standard to different people. People are different and have different situations.

That doesn't, however, invalidate ADHD as a having a physiological origin.

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Please realize that there has been VERY LITTLE research done with children as it pertains to neurochemical imbalances. Hell, they only just recently admitted that giving SSRIs and other anti-depressants to children/adolescents can cause suicidal ideation.

Actually there has been a substantial amount of research on neurochemical imbalances in children.
Here's a whole issue of a leading brain research journal devoted to one type of imbalance: http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234840%231998%23999059998%2315135%23FLA%23&_cdi=4840&_pubType=J&view=c&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ce7971093f4b74f14ce7d2d97494e0b3
There are at least three NIH study sections that deal with the issue:
Biobehavioral Regulation, Learning and Ethology [BRLE] Study Section
Developmental Brain Disorders [DBD] Study Section
Molecular Neuropharmacology and Signaling [MNPS] Study Section

The SSRI issue was not one of lack of technical knowledge or lack of research indicators but of the pharmaceutical market, which is another major issue but still not the original one.

Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[lawrocket 3]

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any other anomoly must b e registered that way to get gov funding. It's all a fucking joke.

You know, of all people who I figured wouldn't have a problem with government funding of something, you are at the bottom of that list. Personally, I disagree with government funding of anything other than basic science (rationale - basic science is done to discover truths without thought of application - therefore, without profit motive because it cannot be patented and is peer reviewed. Applied science and Researh and Development have profit motives, which companies are better equipped to handle).

But this is something that affects everybody, rich and poor and regardless of any other demographic identifier. Apparently, no research has found any corrolation between it and sociological or demographic factors, which separates it from things like Tay-Sachs (high prevalence in Ashkenazi Jews and Quebecois and Lousinan Creoles), sickle-cell disease (African/Middle Eastern/Indian Descent), etc., or even dysentery and tuberculosis (diseases of poverty).

I am stunned that you would find a disease to be unworthy of treatment because of an accused motive of government funding. It is not to say that it does not happen, but to basically allege that the condition was invented by greedy researchers is shockingly arbitrary.

Then again, it's the same bullshit I've heard all my life. Your viewpoint is not unique, which is the reason I do my best to keep my condition under wraps in my community. I certainly do not consider it bullshit, and I, for one, am grateful to the doctors, reasearchers and manufacturers for diagnosis, researching and developing treatments.

My wife is hotter than your wife.

[Scoop 0]

My personal opinion on the matter is it is a genuine condition, of course it is. However, how many people genuinely have ADHD or whatever we're calling it this week and how many doctors just write off bad behaviour as ADHD.

It happens alot over here in the UK. I know one young mum who actually tells her child if he misbehaves that its not his fault, its because he has ADHD. What message does that send to the child?

It has become a term to label children who can't concentrate on tasks, have the discipline to sit still in class, control their tempers etc. Maybe there is a handful there that have the condition, I suggest however the majority of them just arent disciplined enough to do as they are told and respect others around them. I think its sad and this is what the problem is with diagnosis.

[lawrocket 3]

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how many people genuinely have ADHD or whatever we're calling it this week and how many doctors just write off bad behaviour as ADHD.

It's a valid point that you bring up. But any doctor prescribing what in the US is a Class II substance is playing with fire in doing so.

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I know one young mum who actually tells her child if he misbehaves that its not his fault, its because he has ADHD. What message does that send to the child?

A crappy one. Which is the reason why in one of my posts I compared it to giving a kid a glove when he had been playing baseball bare-handed.

For the UK crowd, picture a kid who has been playing footie without cleats - a distinct disadvantage. He looks like a clumsy oaf out there and would be a failure. But give the kid some cleats and his success and competence rise. It does not mean that he is going to be a Bobby Moore, merely that he is not going to be the clumsy oaf anymore unless he really is a clumsy oaf.

The person with untreated ADD/ADHD is playing soccer without cleats. The true test of this is whether the medication reaches the desired effect. Like anyone hoping to improve it takes effort, but it is much, much easier to manage.

My wife is hotter than your wife.

[GravityJunky 0]

Most ADD/ADHD diagnosis are based almost purely on natural observation by UNTRAINED persons (parents and teachers).
Not true anymore anyway, as they have recently isolated a specific gene, that is related to and responsable for ADD/ADHD. Which can be, found/confirmed with a simple inexpesive blood test. The Spect PET scans, utilized are now mainly as an avenue to track, understand... the metabolic, physiological, cognative and emotional symptoms reprecussions etc. of the disorder. Although of course, the also remain an extremely accurate, (though due to cost/accessability, rare) Confirmation of the Diagnosis of ADD/ADHD!

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[GravityJunky 0]

Long story short: in reply to :Isn't it amazing that when you tell the kid to rake the yard or take out the trash, they can find a thousand other things to do, but give them a video game and they can sit still for hours.
It's called Hyper-focusing & it is a recognized trait & symptom of the ADD/ADHD disorder, a trait that is far more frequently responsible for, MISSING a proper ADD/ADHD diagnosis than it is for "over" Diagnosis of same!
People suffering, struggling to live with ADD/ADHD, and overcome it's impediments in so many aspects of live, are no more in control of the symptoms / problems it affects, then someone diagnosed with say diabetes, is responsible in controlling of how much insulin their pancreas is capable of naturally producing, thru sheer willpower/mind/choice! Claiming that an ADD/ADHD afflicted individual, should be capable of controlling the symptoms, problems etc. it creates, with out medical assistance would be as, equivocally ignorant, as making the same claim for someone diagnosed with, say primary hypertension, cancer, diabetes and so many other disorders, diseases, & afflictions!

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[Cudlo 0]

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Most ADD/ADHD diagnosis are based almost purely on natural observation by UNTRAINED persons (parents and teachers).

I think that you and I have different definitions of diagnosis.
As far as I am aware, untrained individuals pretty commonly are the first observers of symptoms, e.g., coughing of bronchitis, flu-like symptoms, pain of a broken leg. A diagnosis is done by someone who is supposed to have some advanced training.

Yes, the diagnosis itself is made by someone who is supposed to be qualified. However, as I said they are often BASED on observations by untrained persons (parents teachers). This is normally done by comparing the results of questionnaires (that have doubtful accuracy) from teacher and parent. However, not even this is always done. I have seen cases where a teacher simply informed the child's physician that the child had AD/HD and that was it, prescription written. I am happy to see that they are making headway in accurately detecting true AD/HD, however, ability and actual application are still divided.
As for the "60% don't check school behavior records", yes I can pull that information back out as I recently just had to research this. It was a survey of pediatricians and physicians, also noted in the survey was that only 38% actually bother to look at the DSM-IV-TR.

_________________________________________
"People demand freedom of speech to make up for the freedom of thought which they avoid." - Kierkegaard

[Andy9o8 0]

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Most ADD/ADHD diagnosis are based almost purely on natural observation by UNTRAINED persons (parents and teachers).

That's complete bullshit. Referrals may be made by parents or teachers, but diagnoses are made by physicians or clinical psychologists.

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I have seen cases where a teacher simply informed the child's physician that the child had AD/HD and that was it, prescription written.

Just because your college research has turned up some anecdotes of that, doesn't make it common, or even a trend.

Just as in the other thread ("McMissile moment" - about the woman convicted of a felony for road rage), where I had to make you understand that having a dad who's a lawyer doesn't make you a lawyer, you also need to appreciate: just because you're a psych major in college doesn't make you a seasoned clinical psychologist, and it certainly doesn't make you a physician. You're doing here what you did in the other thread: taking your presumptions and holding them out to the public as knowledge.

[nathaniel 0]

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NOT by laziness, or lack of discipline or will-power, but a genuine chemical imbalance in the brain

All aspects of the brain are legitimately chemical. That's all the brain is, chemicals. It's entirely devoid of substance to write off something "chemical" as therefore intractable to the mind.

The difference is our science is much better at deducing the chemical than the mental. Pills are exactly a shortcut because we don't fully know the paths that don't involve pills. There's no reason to think that pills are the only way to conquer ADD, and we can expect that even with effective pills that we may find alternatives that don't involve pills.

For example, one recent study of depression found that the benefits of antidepressants set in before the medicine takes effect.

It is tempting to think of the mind and the brain as two separate entities. This is a convenient reduction but it is ultimately self-defeating.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[billvon 2,396]

>That's all the brain is, chemicals.

Well, and electrical potentials. And the structure of the brain plays a role as well, as does blood supply. Just about any attempt to simplify how the brain works necessarily leaves out a lot of what goes on up there.

[Cudlo 0]

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Just because your college research has turned up some anecdotes of that, doesn't make it common, or even a trend.

Wish it had only been anecdotal evidence found while researching. Unfortunately, working at a school I have seen child after child totally screwed up on medication. And I have known them long enough to see them get bounced from prescription to prescription, disorder to disorder. Have you ever seen a child on chemical cocktails of antidepressants, anticonvulsants, uppers and downers to regulate biorhythms, and usually one ore two more just for the cherry on top. It is scary. What is really scary is that a lot of the time the child was prescribed those one after another (countering side effects of the previous drug prescribed) because the parent just "couldn't handle their child". Disgusted that when the child is later taken off the medication he is like how he used to be, and he isn't that bad. The parent just didn't have the time or patience.

Are there disorders where medication is the only recourse? Yes, of course. But when the DSM-IV-TR is so heavily loaded towards the medical model, and the corners that get cut in diagnosis, you end up with alot of kids on heavy psychoactive drugs that shouldn't be.

But hey, of course there isn't anything wrong. Nothing wrong at all. All diagnosis are made perfectly. If something goes wrong it was the kid's fault.

Excuse me now, I need to go sit in a corner and think now. Thank you for putting me in my place and making me understand. Any other worldly knowledge you would like to pass on?

_________________________________________
"People demand freedom of speech to make up for the freedom of thought which they avoid." - Kierkegaard

[Andy9o8 0]

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Any other worldly knowledge you would like to pass on?

Yes; it has to do with humility.
However, it really can't be taught, much less learned, over the Internet.

[SpeedRacer 1]

I think there's a lot to what you're saying. I have a nephew who is basically a decent & intellgent kid, but he's screwing around a lot & his mom lets him get away with it because supposedly he's got ADHD or something similar. She acts as if we shouldn't expect too much from him. The problem is they don't expect ENOUGH of him. Teenagers need to be pushed a little bit. And when they screw up they should be made to face the consequences.

Speed Racer
--------------------------------------------------

[Andy9o8 0]

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I think there's a lot to what you're saying. I have a nephew who is basically a decent & intellgent kid, but he's screwing around a lot & his mom lets him get away with it because supposedly he's got ADHD or something similar. She acts as if we shouldn't expect too much from him. The problem is they don't expect ENOUGH of him. Teenagers need to be pushed a little bit. And when they screw up they should be made to face the consequences.

As the father of 2 teenagers (and as a retired teenager myself), I agree with you. And nothing that you just said is inconsistent with anything that I (or Lawrocket) have said in this thread.

[lawrocket 3]

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Wish it had only been anecdotal evidence found while researching. Unfortunately, working at a school I have seen child after child totally screwed up on medication.

Indeed. It happens quite often. Far too often. And it is likely a consequence that cannot be defeated. It leads to the question of which is more important: 1) treatment of those who need it resulting in treatment of some who do not need it; or 2) eliminating the danger of treating those who need no treatment by not offering it to those who do.

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Have you ever seen a child on chemical cocktails of antidepressants, anticonvulsants, uppers and downers to regulate biorhythms, and usually one ore two more just for the cherry on top.

Actually, no I have not. In fact, the cocktail you describe would possibly kill somebody. Anticonvulsants with antidepressants and uppers and downers?

In fact, how did you know that they were on a cocktail of medications? Did the kids tell you? Or did you have written consents granting you access to these kids' medical records? Or, was HIPAA repeatedly violated in order for you to determine the cocktails these kids were on?

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Disgusted that when the child is later taken off the medication he is like how he used to be, and he isn't that bad.

When were the kids taken off of medication? What have you seen? Your own conclusions or the conclusions of others? Or was this in a clinical setting?

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Are there disorders where medication is the only recourse? Yes, of course. But when the DSM-IV-TR is so heavily loaded towards the medical model, and the corners that get cut in diagnosis, you end up with alot of kids on heavy psychoactive drugs that shouldn't be.

Actually, the medical model would not shortcut objective signs. The medical model, as I recall, is based on set procedures, i.e., complaint, history, tests, diagnosis, etc. What you are complaining about is the LACK of proper utilization of the medical model by making diagnoses and treatments on the basis of conduct and not objectively verifiable pathology.

We call MD's who do this "quacks." We call others who do this "holistic." I think the problem you describe, if anything, is due to veering away from the medical model. I.e., ADHD should continue to be diagnosed the way it was with me 25 years ago - as a diagnosis when everythign else has been ruled out.

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But hey, of course there isn't anything wrong. Nothing wrong at all. All diagnosis are made perfectly. If something goes wrong it was the kid's fault.

Where the hell did THAT come from? I cannot understand how you would give creedence or airtime to a person who would believe that. You shouldn't, either. And if you know of a practitioner who states something to this effect, report this practitioner to his or her licensing agency because that practitioner is a public danger.

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Any other worldly knowledge you would like to pass on?

Yeah, I've got some. Nobody's subjective view of reality is the whole of the objective reality of the world. Not yours, mine, or anyone else's. Your research reveals abuses, which no doubt exist. Your personal experience reveals abuses, which probably exist.

However, your reflection of the basis of your information reveals the high possibility of abuse by you or by those with you. WHo the hell is asking kids to run down what medications they are taking? WHo the hell is scouring their medical records? Those things are protected because of the danger of abuse from the information within them.

I could tell you horror stories of the way people's lives have been irreparably altered because of the release of personal medical information. It was in the name of research or of fact finding, with good intentions. Still, you don't see me arguing that research should not be done.

Edited to add: I am not a health-care practitioner. This is just information I gathered from experience defending upwards of 30 of them before licensing agencies and civil courts.

My wife is hotter than your wife.

[lawrocket 3]

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I think there's a lot to what you're saying. I have a nephew who is basically a decent & intellgent kid, but he's screwing around a lot & his mom lets him get away with it because supposedly he's got ADHD or something similar. She acts as if we shouldn't expect too much from him. The problem is they don't expect ENOUGH of him. Teenagers need to be pushed a little bit. And when they screw up they should be made to face the consequences.

ADHD should not be used as a crutch. Those are the kids who get screwed up because there is no consequence. Grow up in a life without consequences, you become an adult who learns consequences in the hardest way possible.

Have a little chat with your sister. Actually, have a BIG chat with your sister. If you want some talking points, let me know. I'll set aside a half day to let you in on them.

My wife is hotter than your wife.

[GravityJunky 0]

in reply to: ADHD should not be used as a crutch. Those are the kids who get screwed up because there is no consequence.---------
So, exactly what kind of consequences do you recommend?
For ADHD, or Diabetes, or cancer, take them out back and flogg them? Yur Vol' Your Commandant!
Un zen vee move on to za jews again, un den da vons suffering from say, Downs syndrome, Yah!

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[GravityJunky 0]

in reply to: I remember when it used to just be called hyperactivity ------
Actually only about 30yrs ago they were, diagnosing it, and calling it 'Minimal Brain Dysfunction'

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[GravityJunky 0]

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>That's all the brain is, chemicals.
Well, and electrical potentials. And the structure of the brain plays a role as well, as does blood supply. Just about any attempt to simplify how the brain works necessarily leaves out a lot of what goes on up there.

Very well said bill, Thank you!

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[GravityJunky 0]

Obviously MANY of you missed post # 13 on page 1 of this thread. Why don't you check that one out. VERY well said gontleman, Good for you & Thank you!

*My Inner Child is A Fucking Prick Too!
*Everyones entitled to be stupid but you are abusing the priviledge
*Well I'd love to stay & chat, But youre a total Bitch! {Stewie}

[lawrocket 3]

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in reply to: ADHD should not be used as a crutch. Those are the kids who get screwed up because there is no consequence.---------
So, exactly what kind of consequences do you recommend?
For ADHD, or Diabetes, or cancer, take them out back and flogg them? Yur Vol' Your Commandant!
Un zen vee move on to za jews again, un den da vons suffering from say, Downs syndrome, Yah!

Well, how about bad grades as a consequence? Mandatory study halls for failur eto turn in assignments. How about that there is a revocation of privileges for failure to live by the rules?

I understand that plenty think that it should either be to do nothing or to be draconian, but there are middle grounds...

If you recommend draconian punishments, you need to think about it. Punishment can't be arbitrary. Flogging won't do much to a diabetic. At least one with enough peripheral neuropathy - they won't feel it, so what's the point? Force feeding chocolate to a diabetic - THAT'LL SHOW 'EM!

Cancer patients? It depends on the type of cancer. Lock a melanoma patient in a tannign bed and give him sunburn. A kid with leukemia? Make him eat blood sausage.

And ADHD kids? No punishment works - they just don't dwell on punishment like everyone else does.

My wife is hotter than your wife.