Legitimacy of ADD/ADHD (scientific discussion)

ander

After many years of mental health treatment, untreated ADD has come up as a possibility. I have been prescribed accordingly, etc. so I'm not asking for medical advice.

Anyway, For the past week I've been reading on the internet about ADD to educate myself about the disorder, but I've mostly found extreme views (ADD is a conspiracy manufactured by big pharma, turn to Jesus) that didn't present any evidence or sound arguments. So, is ADD 'real'? Is it overdiagnosed?

Reputable sources/thoughtful replies preferred, since this seems to be such a contentious subject.

dimensionless

Some diseases like cancer are acute. You either have it or you don't. Others, such as autism, exist on a spectrum. I can't speak specifically about ADHD, only is broader general terms.

Who is defining what ADHD is? Schools? Doctors? Researchers? Insurance companies? Lawyers?

The question of overdiagnosis would depend on whether the number of people diagnosed with it is greater than the number of people who have it. This doesn't consider that some people have been misdiagnosed with ADHD while others have undiagnosed ADHD.

I believe that ADHD is a true condition. It is not clear to me whether it is normal human variation, or there is something in the brain that is broken. I've never really considered the question and never researched it. But even this, though, is not always black and white, and it raises the question of when to give a label to individuality, which is, by itself, another can or worms.

Calochilus

ADHD is a disorder which is dimensional, ie, you can go from very little to very much. The rational view is that when the aspects central to ADHD, of impulsivity, distractibility and disruption of attention become such that they interfere with your ability to carry out normal life functions , you have a problem. The controversy occurrs in relation to DSM4 (the Diagnostic and Statistical Manual V. 4 of the APA) of which most people only read half . This document is more to do with the management of HMOs rather than patients and overlays categorical determinations on a dimensional framework. This means that you can have few severe symptoms but not make the cut-off for diagnostic certainty (until you read the fine print which most do not).

If impulsivity, distractibility and attention problems cause you to exhibit anxious or depressed behaviours, then there is good reason to think that ADHD may be the primary issue.Treatment of ADHD can be as simple as just having an explanation for a set of behaviours , this insight can do wonders. Mindfulness and other meditative techniques are also of great importance. However, to get to the guts of it, stimulant medication can do almost instantly, anything that other techniques can achieve. The downside is that you still have to do the others to make lifelong changes. Being medicated makes a darn sight easier.. One of the things about ADHD is that as ADDers, we see our world as normal and the neurotypicals as aberrant.
See http://www.alifeofthemind.com/2011/0...ical-syndrome/ :-)
The other issue surrounds the problem of delayed gratification, we like immediate results :-)

In summary, ADHD has a genetic basis (strongly familial as well) A number of candidate genes have been examined but their contribution is small so the problem is highly polygenic. Setting is important, stress is a potent factor in exacerbation of issues. Self medication is the rule, caffeine, nicotine and alcohol head the list, followed by cannabis, street amphetamines and OTC opiates.A valid diagnosis with a legitimate prescription of appropriate medication can reduce the sometimes significant harms of self medication.
Self diagnosis is risky but better than no diagnosis. Do a few on-line questionnaires and learn the parameters of your own issues.
See http://psychcentral.com/addquiz.htm and similar
Remember, ADHD seldom travels alone. Think around co-morbid problems, the primary ones are , of course, anxiety, depression and substance abuse (Yes, Virginia, you can drink TOO much coffee). Something often overlooked is the co-morbid association with Asperger's traits. Particularly relevant in people with high level maths skills .
See http://www.rdos.net/eng/Aspie-quiz.php and similar.
The best source of "gestalt" is to visit (and hopefully join) a patient support group. What you'll find is something quite different to the dry DSM4
See www.addact.org.au and similar
Once you have a handle on your own issues you can then talk rationally with therapists, supervisors, employers and last but not least, family.

AlephZero

This is not a "disease" but a "disorder". In the end it comes down to what society decides is "normal behaviour" and what society decides to do about those who don't fit the "normal" pattern.

BBC radio has a regular program series on health related issues called "Am I normal?" See here http://www.bbc.co.uk/programmes/b007...pisodes/player to listen to some recent ones. I don't think they have ever done one specifically on ADD, but the one on "gifted" children might be interesting.

If society has reached a situation where some behaviour patterns are considered either disruptive to other people, or more or less disfunctional, there is an incentive to try to change those behaviour patterns (either by people trying to change their own behaviour, or trying to impose change on other people - which is of course easier to do if the other people are children). And in a capitalist society, that is an opportunity for people to make money out of the attempts.

If that sounds negative and cynical, anybody out there who wants to persuade me to change my behaviour patterns (and get me to pay them to do it!) is welcome to try ...

Calochilus

I understand where you are coming from. However the term you are looking for is "categorical" rather than "acute". The terms "acute" and "chronic refer to duration and intensity rather than presence or absence. The alternative to "categorical' is "dimensional". (as an aside , it is estimated that as many as 70% of men die with chronic (often symptomless) prostate cancer as opposed to about 1.5% dying from acute prostate cancer
ADHD is indeed, dimensional and shares this with things such as blood pressure, metabolic syndrome and similar disorders where a cut-off along a spectrum is nominated as dividing between "having it" or "not having it"

Like all disorders and diseases, ADHD is defined by peer-reviewed publication, in this case, the American Psychiatric Association in its Diagnostic and Statistical Manual V. 4 (DSM4)
See http://www.psych.org/mainmenu/research/dsmiv.aspx.
While DSM4 is not without both flaws and critics, in the face of nothing better, it serves. However one criticism worth mentioning is that it appears to serve the HMOs better than patients.
In most areas, the rate of diagnosis is far less than the prevalence rate (often around 10% with the exception of USA) . This would suggest that under-diagnosis is common. Confounding issues are that the presence of co-morbid anxiety, depression, dyslexia and other complications mask the true prevalence. About 70% to 80% of children diagnosed with ADHD retain some significant disability in adulthood. If we look at adult diagnoses, we perceive the possibility that significant under-diagnosis in childhood may occur. The issue of misdiagnosis is different. Here there are problems with the cross-over between ADHD and paediatric bipolar disorder, a contentious issue. Also clouding the issue is the occurrence of Oppositional Defiant Disorder, Conduct Disorder, Antisocial Personality Disorder and the waste-basket diagnosis , Borderline Personality Disorder. In the end, does it matter what the label is if treatment is effective?

ADHD is real, it is part of the normal variation in humans. But so then are many other diseases and disorders. Being part of the spectrum of variation does not stop us from attempting to repair Patent Foramen Ovale (hole-in-the-heart) and treating PKU etc.

Mkorr

No. Mental conditions are not diagnosed based exclusively on what "society decides is normal behavior", but rather based on the three Ds: distress, dysfunction and deviance. The two former is often focused around the individual, whereas only the latter has to do with what society deems deviant. These are overarching guiding principle and if we take psychopathy or anti social personality disorder as an example, this mental condition causes almost no distress or dysfunction for the psychopath, but rather for others around him or her and individuals with these mental conditions are viewed as being human predators (in other words, extremely deviant).

Also note that the problems has to be non-transient and have occurred for weeks to months. Almost everyone gets sad sometimes, but very few are consumed by it that they cease to function to a large extent. We call some of these individuals clinically depressed.

Using the "but there is a profit!" argument to cast doubt on psychiatry is futile. Not only is it a logical fallacy (appeal to motive), but in a capitalist society, almost anyone makes money. Should we distrust physics professors just because they make more money than students? No of course not. They (and psychiatrists) should be trusted if reason and the evidence is in their favor, regardless if they make money or not.

You may yourself not be afflicted with a mental condition, but do not presume to talk for others who may be.

Mkorr

It is probably due to both increased awareness and expansion of diagnostic criteria for ADHD has been expanded. So you cannot naively compare apples and oranges and conclude that the actual rates of ADHD has skyrocketed.

Actually, the increase in the diagnosis of autism is not due to some new environmental factor, and certainly not vaccines. Those claims have been debunked. Rather, increased awareness and expansion of diagnostic criteria are the main contributors to the increase in the rates of autism diagnosis.

Gerber, J. S., & Offit, P. A. (2009). ]Vaccines and Autism: A Tale of Shifting Hypotheses. Clinical Infectious Diseases, 48(4), 456-461.

vergatin

ADD/ADHD is indeed real. Most people believe that ADD and ADHD are psychiatric diagnoses and not medical diagnoses. A person cannot be diagnosed with ADD/ADHD[/URL] unless they have 6 or more of 18 symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition.
It's great though that many more studies are being conducted every day to help diagnose, treat, and ultimately cure ADD. Researchers actually found that children with ADD had lower levels of key fatty acids; like omega-3 in their bloodstream. The lack of fatty acids was linked with temper tantrums, memory loss, sleep disturbances, learning difficulties and hyperactivity.

lindamb296

AlephZero, I'm very confused as to how you can seriously include your comments in a discussion titled "(scientific discussion)". First of all, you obviously don't suffer from nor are closely involved with a loved one who suffers from ADD (since this is what I'm personally addressing). If you did or were involved, you would never have ignorantly expressed your biased and totally UNscientific thoughts.

Are ADD and ADHD EXTREMELY and EXCESSIVELY over-diagnosed? YES!!!! I do agree with that. When my son was in Elementary school, they tried to convince me that he was ADD/ADHD and needed to be put on Ritalin. I refused (and his Pediatrician agreed). All my son had was a huge case of being a typical school-age boy--with all the annoying school-age boy characteristics, i.e. talking in class, excessive energy that he released at recess and after school. HOWEVER, that doesn't mean that ADD and/or ADHD doesn't exist.

I speak of this from personal experience. I live in a nightmare world because of ADD. I absolutely cannot sit still and concentrate on anything for more than a few minutes, or, if I'm really lucky, up to half an hour, before my mind drifts, or I get antsy and get up and start wandering around or start doing something else. It makes it real hard to hold down a job or to get anything done around the homestead.

I'm also Bipolar Type 1, Rapid Cycling (and DON'T even try to tell me THAT doesn't exist, because I live in HELL all the time with it yes, even on medication). It makes it real hard to find a medication to treat the ADD tendencies since Adderal and meds like it can cause mania and really send me into a dangerous rollercoaster ride. But without anything, I'm hopelessly unable to complete or concentrate on any task, let alone my work (which pays the bills).

I'm desperate to find a treatment for the ADD tendencies that won't counteract the bipolar meds. I'm miserable, just existing from moment to moment, not living. I accomplish nothing because I can't keep my eye on the target long enough to see the big picture, or reach the finish line so to speak. That's not living, that's just wandering around until it's time to take the sleepy time meds to shut my brain down for 5 or so hours. Then I get to wake up and wander around accomplishing nothing again.

Try that for a day AlephZero, then you come on back here and have a scientific discussion about ADD. I'll wander on back over here every hour or so and check it out.

P.S. it took me about 4 hours to write this. That concentration issue I was mentioning kept effing with me.

Nano-Passion

No your absolutely on the ball park. What defines normal behaviour patterns? In fact, I will argue that the non-adders are the ones that aren't normal- and I would bet that they would be at a disadvantage if it was just nature involved and not society.

Nano-Passion

I happen to think that ADD is a gift--but too much may be a burden. However, the spectrum isn't so well defined. And even worse, it is hard to tell for sure how much of your case is genetic and how much is due to social factors such as paradigms, discipline, and the other myriad of factors that can affect one's ability to turn what seems to be a disadvantage to an advantage.

I probably have it, who knows until I see a doctor next week--but one thing is for sure: I never felt smarter! I now understand myself and my advantages and I'm already changing my thought processes to help me use my creativity and fast thought processes to my advantage.

lindamb296

Nano-Passion & anyone else who cares. I think you sound more bi-polar than ADD, and as I said, I totally know what I'm talking about on that front. In fact, with your "creative" and possibly grandiose "fast (can anyone say manic) thought processes" you are a textbook case for a bipolar individual experiencing a manic episode from the way your describing yourself, but what you are saying is not a description of ADD.

ADD, is not "fast thought processes". I have that going on in my head 24/7 (that's why I have to take meds at night, just to shut my brain down long enough to grab 4 to 6 hours of sleep a night), I'm talking about not being able to grab hold and hang on to even one thought or task for more than a few minutes or, if I'm lucky, an hour. That's not acceptable in the work world at least not with my boss, and it doesn't help in the home front either. The family gets a little tired of all the projects you start that are left unfinished because you lose interest or forget about it because something else distracted you. THAT's ADD.

Nano-Passion

Well, I don't claim to be an expert. But thanks, since you've challenged the train of thought that Add have fast thought processes, it forced me into a bit of research. Coincidentally, I found a page that changed my mind about having ADD.

You said taking ADD helps you sleep? I don't know about other medication but my friend that has ADD told me that adderall (spelling?) is bad for trying to get sleep.

lindamb296

No, I don't take Adderall (which I no longer take b/c it was negatively interacting with my anti-psychotics used to treat bi-polar) nor the vyvanse, to help me sleep--those drugs are stimulants!!!! I take OTHER meds at night to LET me sleep (i.e. to shut my brain down so I can sleep--I take Seroquel--it slows my brain/thought processes down so my natural sleep processes can set in--tol help me sleep). But even with meds, I only get about 5 or 6 hours of sleep per night. In other words, I take stimulants in the day for ADD type symptoms so I can focus and concentrate in order to do my job and at night I take meds to bring me back down so I can get a few hours of sleep.

nitsuj

lol a disorder, yes, by the standard of a bell curve.

By a humane standard, ummm, just another personality type.

I was a hyper-active, class clown who had more "control" over the students than the teachers themselves.

Was proposed I had an Attention Deficit Disorder. lol (more like "over attention spoiled brat disorder"), luckly my mother was a pharmaceutical sales rep... needless to say I was not put on meds. Thank God! (&mom)

What makes ADD distinct from the persons "true self"/personality?

What is a deficit in attention?

What is the disorder? The pattern of attention?

And it effects mostly (only?) children, ?

Was the drug invented first?

R&D heads to marketing department: "We invented this drug that seems to make those obnoxious little kids more mellow. Think there is a market for it?"
Marketing department: "OMG what a gold mine! that market would be huge, there are so many poorly disciplined kids who are also obnoxious / high energy."

Nano-Passion

I think the term attention deficit disorder is a misnomer. Some suggest that it should be called attention surplus disorder, because you put your attention in too many things at the same time.

Pythagorean

Well.. it's a little bit more controversial of a subject. There's a third criteria that you haven't mentioned: the disorder has to cause significant distress to the person or people around them.

For behavioral disorders like ADD, it's generally gauged by the patient's distress, so if you have ADD-like symptoms, but you're not in distress from those symptoms, you actually don't have ADD. Of course, the question of children is always controversial because there's some question of your ownership belonging to your parents.

However, your criticism becomes more valid with personality disorders, where the focus is more on "other people's" distress and of course that becomes subject to different cultural norm (i.e. as a society, we generally aren't worried about the feelings of a sociopath, as ironic as that is; we're worried about them harming people around them)

But we can still go back to the question of distress even with sociopath: some sociopath-like people may adapt and find jobs that fit their "disposition"; i.e. police or firemen, or sky-divers... risk-taking profession. The marked biological symptom of a sociopath is a lack of fear response; it doesn't always lead to a violent jerk. These people might never be considered as sociopaths and they can still recognize social value (even if only at an intellectual or self-preservation level; of course, i'm a cynic too; I think we all operate on self-preservation, just that sociopaths are not as good at fooling themselves about intrinsic social value as the rest of us are).