ADHD Spinoff (Page 2)

gearboy - 2009-05-14 7:12 PM Some clinical and statistical information is clearly called for, especially when people are making claims like "ADHD isn't real" or "ADHD is overdiagnosed" or "Kids are being medicated into zombies".  I will try to be brief, and not to get myself sucked too far into this thread.

ADHD affects, on average 3-6% of kids in a general population; call it 1 in 20 for the sake of argument.  That also means that the average classroom has 1-2 kids with ADHD.  If there are significantly more than that, unless the school has deliberately grouped the kids together, then maybe there is an epidemic of overdiagnosis.

ADHD is a diagnosis made by history.  Symptoms need to be present in a variety of settings and from an early age.  It is not unreasonable for a mother to report a higher level of activity in utero (though that is not typically an age at which is diagnosed or treated).  Multiple reporters are needed, including school and home typically.

Hyperactivity is not the hallmark symptom.  Symptoms related to attentional regulation are key  - initiating attention, sustaining attention to task completion, shifting attention when needed, freedom from distractibility, etc.  There are very specific brain regions involved, that can be identified with PET scans, though it is not a reliable sort of test.

There is also a higher need for novelty seeking. Which means that rewards lose effectiveness more quickly than in non-ADHD people. (This is a somewhat newer finding, which parents have long noted when they would tell me and my fellow kiddie shrinks "nothing works" when we would talk about using positive reinforcement.  Because the novelty wears off more quickly, and finding a reward is a constant struggle. Who knew?)

People can learn to modulate their symptoms.  Brains develop typically though people's mid-20's, which means some people with minor symptoms may truly outgrow symptoms; and other people can learn coping skills, and that some people (up to as many as 50%) still have symptoms needing treatment in adulthood.  Symptoms are things which interfere with daily functioning.

Kids with ADHD have about 50% chance of a parent with ADHD.  Which means when you blame the parenting, you may in fact be dealing with the parent's symptoms relating to routines.

Stimulant medications improve focus and concentration.  Too much medicine results in a a phenomena known clinically as "over-focusing".  But known to parents/teachers as "doped up zombie".  So meds do not automatically cause kids to be zombies.  Oversensitivity to meds or too high a dose does.

Kids under 6 or 7 have unpredictable responses to medicine.  Fortunately relatively few kids this age are candidates for meds as diagnosis is less clear.  Sometimes a few more years of symptoms in additional settings are needed to be certain of the diagnosis.

Untreated ADHD kids have higher rates of drug abuse in adolescence, higher rates of teen pregnancy, drop outs, academic problems, minor MVA's, and legal problems. They also have higher rates of Oppositional Defiant Disorder (what I like to call the "You're Not The Boss Of Me" disorder).

And on a personal note, despite my years of experience diagnosing and treating ADHD, the thing that MOST brought home to me the impact of this on kids and their daily functioning (school, peers, etc) was the year I ran a troop of girl scouts (10-12 year olds).  One girl had untreated ADHD.  It was a nightmare for me as the leader, she alienated other girls to the point that one of them who later befriended my daughter years later was STILL talking about her negatively.  She was a big reason that I only did this ONE year, and I am really, really, really glad I am not a teacher having to deal with this everyday without the ability to point it out to parents.

run4yrlif - 2009-05-15 8:17 AM

This is one persons criteria for ADHD.  I have yet to find any generally accepted and agreed upon medical and/or psychological criteria for ADHD diagnosis. 

Imjin - 2009-05-14 5:14 PM Please dont take this personally as its not meant to be but I am sure theres no way it wont be.

The problem is all of the "problems" you mentioned could just be explained by a difference in personalities couldnt they?

One attacks homework and one doesnt. One seems distracted and one doesnt.

The sudden jump with medicating our children into submission is disturbing. That is not to say that some children wont benefit and that there arent children that have issues but far to often I have seen parents taking their children to the doctor for help when it is very obvious that the issue is a lack of something in the home ( this is not directed at you but rather families from my own life)

My ex wife is a perfect example. My daughter is the child most parents would want. Her brother and sister from my exs second marriage could walk into some doctors offices and EASILY be diagnosed  with ADHD but you know what, its how she raises them. She has talked to me about it quite a bit and it just comes down to her parenting skills and a lack of consistant discipline. My daughter has rules and consequences and they are enforced.Her brother and sister dont.

Also another sad trend is a"kid being  a kid". I have talked to far to many young parents who freak out when their kids are being kids and state " OMG I cant control this kid. I think he has ADHD"  Sadly there are doctors who will medicate them instead of suggesting that the child is fine and the parent needs the help.

Now obviously as I said there are legit cases and who knows what the percentage is but I do feel that some healthcare profesionals are far to quick to medicate.My mother spent 30 years working for the local school district and while there were children who were diagnosed and were helped there was a definite jump in the amount of cases that the childrens teachers didnt agree with. The children suffered


That being said I have a friend who was diagnosed and it changed his life. You can still tell that he is someone who it would have benefited after being around him for a few days.

This is atouchy subject and hopefully no one took it  as an attack on them or their children because I was speaking of people that I actually know.

TriRSquared - 2009-05-15 8:42 AM

The DSM-IV is more than "one person's" criteria, right?

Reno8 - 2009-05-14 7:15 PM

The problem is not totally, that someone can't pay attention,  it is that they can't focus on just one thing.  They seem to think it goes back to the Hunter/Gatherer thing where if you didn't pay attention to about 10 things at once you would would wind up being some animals supper instead of coming home with some supper.  People with ADD can keep track with many things at once.  True...they are not a "focused" on the given task as a "normal" person but can usually get most of it and still tell you what is going on outside the window or in the next office over. 

This helped me greatly with my job an a Battalion Chief with a large Fire/Rescue department...being able to keep track of many, many things happening simultaniously is what made me do my job much better and easier than the very uni-focused guys that did better in classroom stuff.

3....I wholehearted agree that it is over diagnosed.

4....One of the best things I have ever read (and I have read a BUNCH over the 18 years since my oldest was first tested) is that ADD/ADHD is really a gift.  Most who have it score higher on intelligence tests, most have much better hand/eye coordination, most handle emergency type stress better and while there are certainly difficulities if proper medication and cognitave therapy are given people with the disorders can be outstanding members of society.

Just my thoughts

Steve

eabeam - 2009-05-15 12:12 PM For those that have, or think they have (or parents of) ADHD, I would like to make two recommendations.

1. Taking charge of ADHD by Russell Barkley.  The best scientific and reasonable book on the topic for lay people. If you are a professional, read ADHD and the nature of self control.

2. Avoid CHADD, they left the realm of helping people with ADHD a long time ago. In my opinion, they are all about political activism - in many cases - is counter productive in the long run.

AcesFull - 2009-05-15 1:50 PM

I've hesitated to weigh in, and am glad Gearboy has said his piece.  First, to establish my credential and perspective.  I am a clinical psychologist.  My primary training and experience is in treating adults, but I have had ample opportunity to assess children in the past, and am very familiar with diagnosing this disorder.  I have little to add, as Gearboy and others have done a very thorough job.  A few points worth underscoring:

 This is not and should not be a diagnosis made lightly.  With apologies to primary care docs, most (not all) are not well trained in differentiating between ADHD and the myriad childhood problems that may mimic ADHD.  I also see an appalling tendency on the part of mental health professionals, especially those who treat adults only, to diagnose ADHD in adults where there is no history of symptoms prior to age 7.  A good history is vital in making this diagnosis. 

I see grave damage done to children with depression or some other ailment, who are given meds for ADHD.  I also see grave damage done to children who have ADHD, but whose parents refuse meds for their child, or are talked out of meds by well-meaning family. 

There are dangers in people taking positions like that of the OP.  Most problematic is that they sometimes prevent people from getting a good diagnostic workup.  Moreover, postions such as this blame the parent, when there is generally no cause to do so.

 

AcesFull - 2009-05-15 2:50 PM

I've hesitated to weigh in,

AcesFull - 2009-05-15 11:50 AM

There are dangers in people taking positions like that of the OP. 

AcesFull - 2009-05-15 1:21 PM

Sorry.  Had to wait until I could formulate a response that would not be a rant.

trinnas - 2009-05-15 3:23 PM I have stayed away from posting in this thread becuase the original post really bothers me.  One of the reasons it bothers me is binig the mother of a 12 year old ADD boy diagnosed in first grade I have gotten to see the dark side of this type of attitude.  Including having to defend myself to child services when a teacher reported me because I disagreed with her and refused to punish my son for something she thought I should punish him for.  It is a long and complex story but suffice it to say any time any thing happened it was always my sons fault he could do no right in her eyes.  When my husband and I tried to work with her she would say she didn't have the time to let us know what was happening in class on a regular basis we would just have to wait until parent teacher confrence time.  I quit going to PT confrences when 2 wks after the confrence where I told her she was wrong I was defending myself against sexual abuse charges she had leveled at me.  Yes they are supposed to be confidential but the allegations and the supporting "evidence", and I use the term very lightly, pointed to her.  Her behavior at a confrence involving the pricipal confirmed my suspicion.  She had originally accused me of sexually abusing my son but when she couldn't support that she dropped it down to exposing my son to sexually explicit material.  I was easily cleared of all allegations but this is the sort of thing, and it is only one example, of the dark side of the ADD is bunk mentality.  This teacher used my son's condition to turn him into a scapegoat and then went after me when I fought for my son's rights.

gearboy - 2009-05-15 8:47 AM I really should be working right now, but it looks like I opened up a big old can of worms.  I'll try to address the various questions/comments that followed my last note -

TriRSquared (and now your handle makes sense to me, being that you're an engineer) - in my opinion, ADHD is both under and overdiagnosed.  What I mean is that there are people I've seen at all ages who clearly should have been diagnosed much earlier than when I saw them, so they are underdiagnosed.  I've also seen people who I thought were misdiagnosed, hence the overdiagnosis.  I think primary care docs are more apt to overdiagnose, but that may just be an unwarranted prejudice on my part as a specialist.  I also know if all you have is a hammer, everything is a nail, and that docs who subspecialize in "ADHD treatment" will tend to overcall it as well.  They are also more likely to get referrals in the first place for difficult ADHD.  The best way to gauge in an area if it is over or underdiagnosed is to get a random population sampling. True story - year ago, I was helping mrs gearboy (who is big in girl scouts here) at a large multi-troop event.  One of the kids had some minor mishap, so I grabbed her medical history form, and was shocked to see that, at random, she was on a variety of psych meds (not my patient).  I got worried that my community is overmedicating kids, so I went through the rest of  the forms (this was valid, since I was co-first aid-er, and therefore had a right to access the forms).  This was the only kid on multiple meds.  Overall, about 5% of the kids were on some treatment for ADHD, and the one kid on multiple meds therefore was an outlier (but also statistically valid for how many kids were present and how many should have had what I suspect she was diagnosed with, given her meds).  There were a lot of kids on asthma meds, but I have no idea what the stats are for prevalence of asthma and whether is was too high.

Run4yrlif - tri4squared already later pointed this out, but the diagnostic criteria are outlined in the DSM.  the specific details may change with time as we learn more about any given disorder, but the overall qualities should not change much. Sometimes we merge disorders (like "overanxious disorder of childhood" left the DSM III-R to become part of "generalized anxiety disorder" in DSM-IV); sometimes we split out disorders (like Asperger's syndrome got officially recognized despite being first described in the 1940's only inthe DSM-IV).  But in general, there is an overreaching sense of things.  Sort of like you can tell me several shades of paint are all "red", but they might have specific differences in tone.

Imjin - the reason there is a range of %s is that we pool data from the best studies.  Different studies use different rating scales, or may be more or less rigid.  So the issue of estimating prevalence has to do with statistical analysis (not my strong area).  Community rates may well differ than the studies report, and should be viewed more skeptically.  Again, though, the devil is in the details.  Studies of kids in mental health clinics obviously have much higher rates than a community sample, or primary care office. I agree there are times where diagnosis is made on flimsy evidence, and sometimes people jump to meds too quickly.  I should also point out that I believe there is a firm role for therapy, initially to help parents understand and manage a kid with ADHD, and later to help a teen with ADHD learn self-managing skills.

As for "Oh great another disorder to describe anti social behavior? This is human nature to some people unless it is just grossly out of wack" - Conduct disorder is antisocial behavior.  And unless you hang out with a very different group of people than I do, it is not "human nature" to rob people at gunpoint, use weapons to cause serious physical harm, commit arson, torture animals, engage in burglary and theft, etc.  And maybe I should not use so much "shorthand", but part of the criteria of both ODD and Conduct Disorder (as well as ADHD) is that the symptoms have to cause "clinically significant impairments in social, academic, or occupational functioning" - is that "grossly out of wack"?  Also for ODD, the oppositionality needs to be more frequent than typical for age and developmental status.

roch1009 makes a very important point when talking about the 100 kids - ADHD is a spectrum, not a categorical disorder.  Categorical disorders are things like pregnancy (yes, yes, I know, pregnancy is not a disease, it's part of the rich human experience, blah, blah, blah) - Anyway, the point is you are pregnant or you are not.  ADHD or, say, hypertension, are spectrums disorders.  At some point, the symptoms (or pressures) are high enough and persistant enough to qualify as a disorder.  Where do we draw that line?  A few years ago, the American Heart Association changed the numbers needed to be diagnosed as hypertension.  Why?  It was found that damage occured at statistically significant rates with the lower numbers.  But I could have an elevated reading at any given time without being diagnosed with hypertension.  Similarly, I might occasionally be hyper or off-task, and not be diagnosed.  Or I am only slightly more "off" than a kid next to me.  That's one of the reasons that classroom observations are helpful - there is a "norm" group of 20-30 kids to be compared to in terms of off task behaviors.  I won't rehash everything else I already said, just reiterate roc1009's point that it is a disorder that exists on a spectrum.

And now I have to get back to work for the rest of the day.

TriRSquared - 2009-05-15 8:13 AM

What I find most interesting is your statement that 3-6% of children have it.  That's pretty low in my opinion.  It's not too far off the quote I edited to make my initial point.  It's pretty small.