7 ms·

>If you're a person who reads the description of ADD and says that it sounds like you, maybe a lot. I feel this unfairly divides ADD between "people who think

by criley 14y ago

>If you're a person who reads the description of ADD and says that it sounds like you, maybe a lot. I feel this unfairly divides ADD between "people who think they have" and "people who have" but in my experience this is a horrible line to draw. Many doctors will listen for a stock phrase and hand out a one page questionnaire and diagnose you with adult on-set ADD on the spot. Bam, then you "have" it, doctor verified and everything. And yet, that person who "has" it may be no different than the one who read what is basically the same questionnaire online.

chimeracoder 14y ago
Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid. All doctors, from radiologists to orthopedic surgeons, are told not to self-diagnose, and psychiatric conditions are the easiest to improperly self-diagnose, even for trained professionals (which most people on HN are not). On top of that, ADHD is one of the most difficult conditions to properly diagnose. Unlike more overt disorders, like schizophrenia, the symptoms are less clear-cut, and unlike more visible disorders, like (true) OCD[0], the symptoms usually lie two or three layers deep, making it easy to confuse the cause of the symptoms if you're not careful. There exist differential diagnoses for this purpose (disambiguating the cause of the symptoms); most people just don't have them done, because they're incredibly expensive (several thousands of dollars), as they're very time-intensive on the part of the doctor. That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous. ADHD is perhaps inappropriately named, yes, but that suggestion is like saying that the cure to depression is to "stop being sad". [0] I say "true" to distinguish clinical obsessive-compulsive disorder from the casual use of the term (eg, "oh man, my OCD kicked in when I saw Comic Sans mixed with Papyrus").
- randallsquared 14y ago
  > Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid. It calls into question, somewhat, whether there actually are any valid diagnoses, if a disease is well-known to be very commonly diagnosed improperly.
  - btilly 14y ago
    In the case of ADHD there happens to be sufficiently good evidence of real cases, along with brain scans showing what is happening inside of the brain, that we can be very confident that the disorder is real. However if a random person claims to have it, we may not be confident that they were correctly labeled.
- _delirium 14y ago
  > That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous. There's quite a bit of research on the subject, and researchers don't generally consider a relationship preposterous. It's reasonably well established that sleep disturbances and sleep deprivation can at least exacerbate the symptoms of ADHD. Some research suggests that they may also be a risk factor for developing the condition in some cases, or alternately (depending on unresolved questions about etiology) that a differential diagnosis is needed to distinguish non-sleep-related ADHD from symptoms related to sleep disorders. The diagnoses do empirically seem to co-occur quite frequently, which is one factor driving the research, but the mechanisms aren't well understood. Nature published a short review of the (very large) literature on the subject last year: J. Cassof et al., Sleep patterns and the risk for ADHD: a review, Nature 2012(4): 73-80.
btilly 14y ago
The division here is between the underlying causes of the distractibility. And that's a pretty important distinction to make. Many things can cause distractibility, from sleep deprivation to thyroid disorders. ADD/ADHD is only one of them. The effective treatment for any of these will not help the others. That is why the DSM-IV includes as a diagnostic criteria that you have to screen for other possible causes of the behavioral issues and rule them out. The "many doctors" that you describe are simply not doing their job properly. By comparison the screening process for my son's diagnosis took about a month. Possibly not coincidentally I live in California - a state that has one of the lowest rates of diagnosis of ADD and ADHD. (Look at http://www.cdc.gov/ncbddd/adhd/prevalence.html http://www.cdc.gov/ncbddd/adhd/prevalence.html to see your state diagnosis rate - I'd be suspicious of any diagnosis made in Alabama.) I am confident that my son's diagnosis is correct - my son has responded well to medication, while children without the disorder don't. So here is my point again. If you're noticeably distractible and possibly sleep deprived, try getting more sleep. It might make a big difference. If you've actually got ADHD or ADD it won't hurt you, but it won't fix the problem either. There are other things that can also produce the same symptoms. Go to a competent doctor if you've got reason to be concerned.
- deleted 14y ago
  [deleted]
- GHFigs 14y ago
  The effective treatment for any of these will not help the others. This isn't entirely true. A person that isn't getting enough sleep can "fix" the problem with ADD medications, and thus maintain the erroneous belief that they have ADD and therefore require that medication. How often that happens is debatable, but it is one of the (many) things that lead to over-diagnosis.
  - btilly 14y ago
    Good point. And since a side-effect of the medication is trouble sleeping, I could see a vicious cycle starting.

by criley 14y ago

chimeracoder 14y ago

Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid. All doctors, from radiologists to orthopedic surgeons, are told not to self-diagnose, and psychiatric conditions are the easiest to improperly self-diagnose, even for trained professionals (which most people on HN are not). On top of that, ADHD is one of the most difficult conditions to properly diagnose. Unlike more overt disorders, like schizophrenia, the symptoms are less clear-cut, and unlike more visible disorders, like (true) OCD[0], the symptoms usually lie two or three layers deep, making it easy to confuse the cause of the symptoms if you're not careful. There exist differential diagnoses for this purpose (disambiguating the cause of the symptoms); most people just don't have them done, because they're incredibly expensive (several thousands of dollars), as they're very time-intensive on the part of the doctor. That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous. ADHD is perhaps inappropriately named, yes, but that suggestion is like saying that the cure to depression is to "stop being sad". [0] I say "true" to distinguish clinical obsessive-compulsive disorder from the casual use of the term (eg, "oh man, my OCD kicked in when I saw Comic Sans mixed with Papyrus").

randallsquared 14y ago
> Yes, there are bad doctors, and there are cursory or improper diagnoses, but that does not make the valid diagnoses any less valid, or the invalid diagnoses any more valid. It calls into question, somewhat, whether there actually are any valid diagnoses, if a disease is well-known to be very commonly diagnosed improperly.
- btilly 14y ago
  In the case of ADHD there happens to be sufficiently good evidence of real cases, along with brain scans showing what is happening inside of the brain, that we can be very confident that the disorder is real. However if a random person claims to have it, we may not be confident that they were correctly labeled.
_delirium 14y ago
> That said, the entire claim which precipitated this discussion - that ADHD is somehow related to sleep deprivation - is completely preposterous. There's quite a bit of research on the subject, and researchers don't generally consider a relationship preposterous. It's reasonably well established that sleep disturbances and sleep deprivation can at least exacerbate the symptoms of ADHD. Some research suggests that they may also be a risk factor for developing the condition in some cases, or alternately (depending on unresolved questions about etiology) that a differential diagnosis is needed to distinguish non-sleep-related ADHD from symptoms related to sleep disorders. The diagnoses do empirically seem to co-occur quite frequently, which is one factor driving the research, but the mechanisms aren't well understood. Nature published a short review of the (very large) literature on the subject last year: J. Cassof et al., Sleep patterns and the risk for ADHD: a review, Nature 2012(4): 73-80.

btilly 14y ago

The division here is between the underlying causes of the distractibility. And that's a pretty important distinction to make. Many things can cause distractibility, from sleep deprivation to thyroid disorders. ADD/ADHD is only one of them. The effective treatment for any of these will not help the others. That is why the DSM-IV includes as a diagnostic criteria that you have to screen for other possible causes of the behavioral issues and rule them out. The "many doctors" that you describe are simply not doing their job properly. By comparison the screening process for my son's diagnosis took about a month. Possibly not coincidentally I live in California - a state that has one of the lowest rates of diagnosis of ADD and ADHD. (Look at http://www.cdc.gov/ncbddd/adhd/prevalence.html http://www.cdc.gov/ncbddd/adhd/prevalence.html to see your state diagnosis rate - I'd be suspicious of any diagnosis made in Alabama.) I am confident that my son's diagnosis is correct - my son has responded well to medication, while children without the disorder don't. So here is my point again. If you're noticeably distractible and possibly sleep deprived, try getting more sleep. It might make a big difference. If you've actually got ADHD or ADD it won't hurt you, but it won't fix the problem either. There are other things that can also produce the same symptoms. Go to a competent doctor if you've got reason to be concerned.

deleted 14y ago
[deleted]
GHFigs 14y ago
The effective treatment for any of these will not help the others. This isn't entirely true. A person that isn't getting enough sleep can "fix" the problem with ADD medications, and thus maintain the erroneous belief that they have ADD and therefore require that medication. How often that happens is debatable, but it is one of the (many) things that lead to over-diagnosis.
- btilly 14y ago
  Good point. And since a side-effect of the medication is trouble sleeping, I could see a vicious cycle starting.