4 ms·

ADHD: A Disease called childhood

13 points by imperio59 12y ago

cafebeen 12y ago
"If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?" Sigh, there is plenty of scientific evidence of a biological basis of ADHD, i.e. genetic and neuroimaging studies: http://www.ncbi.nlm.nih.gov/pubmed/22306277 http://www.ncbi.nlm.nih.gov/pubmed/22306277 https://www.youtube.com/watch?v=LyDliT0GZpE https://www.youtube.com/watch?v=LyDliT0GZpE Of course, we don't know what is causing these differences, and false positives are a real problem, but the misinformation in this article is very irresponsible
geoelectric 12y ago
No question that ADHD is overdiagnosed. It's probably also underdiagnosed. Some people who aren't are called ADHD; some people who are never get help. It also most certainly exists--I wasn't diagnosed until middle adulthood, but the pattern of chaos back to childhood was pretty obvious, especially in hindsight. My life would be far different, and probably better in many ways, had I gotten the help I needed then. Problem was, this same sort of pop psychology diagnosis denial existed in the 70s and 80s, and my parents wrote the teacher referral off. Wish they hadn't. This whole article talks about the concept of ADHD stigmatizing normal behavior, but the diagnostic guidelines include A) that the subject isn't behaving in an age-appropriate way and B) that the issues are causing significant real-life problems in at least two settings. There are multiple checkpoints that the behavior isn't normal, not transitory, not limited to problems with one place or person, and not easily addressed or tolerated by the individual showing it. I'm absolutely certain that some parents, teachers, GPs, even psychiatrists err on these, that the kid is just showing a minor developmental lag or a contextual issue. But at the same time, the people it helps, it helps a lot, and at a really crucial time. School is a terrible, terrible place to not be able to get shit done and to establish bad life habits, which is ultimately what ADHD will do. Doesn't take much at that stage to ruin high school, college, chances at a career. So yeah, skepticism, sure. ADHD needs even more tried and tested diagnostic criteria. And ADHD is largely an umbrella diagnosis with treatments mitigating secondary symptoms of unknown primaries, so we should keep looking for primary causes and address those. But to write off the whole thing...I don't know. I think that kind of overreaction is irresponsible. Marilyn Wedge has more or less built her current career on this position, but my own experience, however anecdotal, and any number of peer-reviewed studies don't really back her story very well. And really, those of us who suffer from ADHD already face enough stigma and baggage without having pop psych articles in Time Magazine trying to invalidate the one pathway that actually has led to some degree of relief and success.
- pc2g4d 12y ago
  But what you've said doesn't mean you have a disease---it could just mean that what society expects of you is unreasonable given your temperament.
  - geoelectric 12y ago
    It's not a disease, it's a disorder. Big difference. One is a cause, the other (edited) is a collection of symptoms with unclear origin, but which happen together enough to be their own thing. It's pretty likely different people acquire dysfunction from different circumstances, whether traumatic, epigenetic, genetic, or whatever else interacts with brain development. But to your point, and without going into a bunch of personal info, I doubt it. There were plenty of issues and deficits that I can't imagine being appropriate in any setting. Moreover, ADHD has been acknowledged for a long, long time. The term is modern, but the disorder is not. It was minimal brain damage, IIRC, prior to ADHD, and had a bunch of increasingly archaic terms as you go back. You have to understand, the popular view of ADHD--stereotypical hyperactivity and scatterbrained behavior--yeah, those are part of it, but they're not the whole. The cluster of symptoms mimics prefrontal cortex damage. Executive function is responsible for a whole lot of stuff. If you're willing to acknowledge that mental disability exists in general, and that there's a line where we say, OK, that person is impaired, then it's not a huge jump to understand that it can exist in specific physical areas too. When it affects executive function to whatever degree you're going to draw that line, that's ADHD.
    - supercanuck 12y ago
      >It's not a disease, it's a disorder. Big difference. One is a cause, the other is a collection of symptoms that are frequently observed together, and which cause an issue. I'm not able to tell the difference about which one you are talking about even after reading your definition. Maybe there isn't much of a difference after all?
      - geoelectric 12y ago
        Disease is a root cause, disorder is a manifestation that either comes from an unknown root cause or from several root causes with the same effect. Alternately, Google it. I'm not a doctor, and I'm sure it's explained better elsewhere.
yellowapple 12y ago
As someone who was once upon a time diagnosed with ADD (I didn't quite cross the threshold into ADHD according to my pediatrician at the time), I can relate to this, at least a little bit, and I agree with most of what's discussed. That said: According to a recent study by the Centers for Disease Control and Prevention, 14 percent of schoolchildren are currently diagnosed with ADHD in Arkansas and Louisiana. In Nevada, the number is less than 5 percent. If ADHD were truly a genetically based biological disease, wouldn’t the percentage of children diagnosed with it be more or less equal across geographical areas? Probably not. Genetic diversity, at least in nature, tends to correspond to geographic separation of populations. I'd be surprised if this was significantly different for humans, particularly those on almost-opposite sides of the U.S.
nickysielicki 12y ago
Via /r/adhd: >"In her book she advocates a "gluten free diet" and makes the repeated claims that "big pharma" are pushing these drugs on kids, who are simply a bit "different"" I don't know about you, but IMO if a person is advocating against gluten to cure ADHD, they probably aren't worth listening to on anything. If you want to have an informed opinion on ADHD, watch this video: https://www.youtube.com/watch?v=SCAGc-rkIfo https://www.youtube.com/watch?v=SCAGc-rkIfo

13 points by imperio59 12y ago

"If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?" Sigh, there is plenty of scientific evidence of a biological basis of ADHD, i.e. genetic and neuroimaging studies: http://www.ncbi.nlm.nih.gov/pubmed/22306277 http://www.ncbi.nlm.nih.gov/pubmed/22306277 https://www.youtube.com/watch?v=LyDliT0GZpE https://www.youtube.com/watch?v=LyDliT0GZpE Of course, we don't know what is causing these differences, and false positives are a real problem, but the misinformation in this article is very irresponsible

geoelectric 12y ago

No question that ADHD is overdiagnosed. It's probably also underdiagnosed. Some people who aren't are called ADHD; some people who are never get help. It also most certainly exists--I wasn't diagnosed until middle adulthood, but the pattern of chaos back to childhood was pretty obvious, especially in hindsight. My life would be far different, and probably better in many ways, had I gotten the help I needed then. Problem was, this same sort of pop psychology diagnosis denial existed in the 70s and 80s, and my parents wrote the teacher referral off. Wish they hadn't. This whole article talks about the concept of ADHD stigmatizing normal behavior, but the diagnostic guidelines include A) that the subject isn't behaving in an age-appropriate way and B) that the issues are causing significant real-life problems in at least two settings. There are multiple checkpoints that the behavior isn't normal, not transitory, not limited to problems with one place or person, and not easily addressed or tolerated by the individual showing it. I'm absolutely certain that some parents, teachers, GPs, even psychiatrists err on these, that the kid is just showing a minor developmental lag or a contextual issue. But at the same time, the people it helps, it helps a lot, and at a really crucial time. School is a terrible, terrible place to not be able to get shit done and to establish bad life habits, which is ultimately what ADHD will do. Doesn't take much at that stage to ruin high school, college, chances at a career. So yeah, skepticism, sure. ADHD needs even more tried and tested diagnostic criteria. And ADHD is largely an umbrella diagnosis with treatments mitigating secondary symptoms of unknown primaries, so we should keep looking for primary causes and address those. But to write off the whole thing...I don't know. I think that kind of overreaction is irresponsible. Marilyn Wedge has more or less built her current career on this position, but my own experience, however anecdotal, and any number of peer-reviewed studies don't really back her story very well. And really, those of us who suffer from ADHD already face enough stigma and baggage without having pop psych articles in Time Magazine trying to invalidate the one pathway that actually has led to some degree of relief and success.

pc2g4d 12y ago
But what you've said doesn't mean you have a disease---it could just mean that what society expects of you is unreasonable given your temperament.
- geoelectric 12y ago
  It's not a disease, it's a disorder. Big difference. One is a cause, the other (edited) is a collection of symptoms with unclear origin, but which happen together enough to be their own thing. It's pretty likely different people acquire dysfunction from different circumstances, whether traumatic, epigenetic, genetic, or whatever else interacts with brain development. But to your point, and without going into a bunch of personal info, I doubt it. There were plenty of issues and deficits that I can't imagine being appropriate in any setting. Moreover, ADHD has been acknowledged for a long, long time. The term is modern, but the disorder is not. It was minimal brain damage, IIRC, prior to ADHD, and had a bunch of increasingly archaic terms as you go back. You have to understand, the popular view of ADHD--stereotypical hyperactivity and scatterbrained behavior--yeah, those are part of it, but they're not the whole. The cluster of symptoms mimics prefrontal cortex damage. Executive function is responsible for a whole lot of stuff. If you're willing to acknowledge that mental disability exists in general, and that there's a line where we say, OK, that person is impaired, then it's not a huge jump to understand that it can exist in specific physical areas too. When it affects executive function to whatever degree you're going to draw that line, that's ADHD.
  - supercanuck 12y ago
    >It's not a disease, it's a disorder. Big difference. One is a cause, the other is a collection of symptoms that are frequently observed together, and which cause an issue. I'm not able to tell the difference about which one you are talking about even after reading your definition. Maybe there isn't much of a difference after all?
    - geoelectric 12y ago
      Disease is a root cause, disorder is a manifestation that either comes from an unknown root cause or from several root causes with the same effect. Alternately, Google it. I'm not a doctor, and I'm sure it's explained better elsewhere.

yellowapple 12y ago

As someone who was once upon a time diagnosed with ADD (I didn't quite cross the threshold into ADHD according to my pediatrician at the time), I can relate to this, at least a little bit, and I agree with most of what's discussed. That said: According to a recent study by the Centers for Disease Control and Prevention, 14 percent of schoolchildren are currently diagnosed with ADHD in Arkansas and Louisiana. In Nevada, the number is less than 5 percent. If ADHD were truly a genetically based biological disease, wouldn’t the percentage of children diagnosed with it be more or less equal across geographical areas? Probably not. Genetic diversity, at least in nature, tends to correspond to geographic separation of populations. I'd be surprised if this was significantly different for humans, particularly those on almost-opposite sides of the U.S.

nickysielicki 12y ago

Via /r/adhd: >"In her book she advocates a "gluten free diet" and makes the repeated claims that "big pharma" are pushing these drugs on kids, who are simply a bit "different"" I don't know about you, but IMO if a person is advocating against gluten to cure ADHD, they probably aren't worth listening to on anything. If you want to have an informed opinion on ADHD, watch this video: https://www.youtube.com/watch?v=SCAGc-rkIfo https://www.youtube.com/watch?v=SCAGc-rkIfo