ADHD: Isit Overdiagnosed, and if so why?

[T.A.M.]

I apologize in advance if this topic has been done to death, but others have expressed a desire to discuss this, so...

Recently in the CT subforum a topic that spawned from another was the issue of ADHD, its over or under diagnosis, the role of the pharmaceutical industry and others in its categorization and diagnosis.

Here is my 2 cents:

1. ADHD has likely existed for sometime. It is only in modern medical times that we have categorized it, and subsequently started treatment for it.
2. The most common treatment for ADHD, Ritalin, is a generic drug, and hence is not pushed by any given brand name Pharmaceutical company.
3. As of late, the involvement, and pressure, from teachers and school guidance counsellors to evaluate and diagnose children with the illness/condition has grown nearly exponentially, and I suspect this is a combination of (A) educated teachers and counsellors, (B) Educated parents, (C) in many cases over zealousness to counter what may simply be "acting out" or Rebelliousness.

I welcome all comments, on mine, or on the topic in general.

TAM

 

[Liszt]

hi TAM

I started a thread while you were busy treating people. It starts of mental (because it was in the CT subforum, natch) but after it was moved here, it improved dramatically.

check out Z's post. I thought he was spot on.

 

[athon]

I apologize in advance if this topic has been done to death, but others have expressed a desire to discuss this, so...

Recently in the CT subforum a topic that spawned from another was the issue of ADHD, its over or under diagnosis, the role of the pharmaceutical industry and others in its categorization and diagnosis.

Here is my 2 cents:

1. ADHD has likely existed for sometime. It is only in modern medical times that we have categorized it, and subsequently started treatment for it.
2. The most common treatment for ADHD, Ritalin, is a generic drug, and hence is not pushed by any given brand name Pharmaceutical company.
3. As of late, the involvement, and pressure, from teachers and school guidance counsellors to evaluate and diagnose children with the illness/condition has grown nearly exponentially, and I suspect this is a combination of (A) educated teachers and counsellors, (B) Educated parents, (C) in many cases over zealousness to counter what may simply be "acting out" or Rebelliousness.

I welcome all comments, on mine, or on the topic in general.

TAM

I'm coming at this from a person who has a degree in genetics, experience in clinical pathology and most recently in education.

The human species has a variation of phenotypic traits. These create variations in physiology, behaviour, disease susceptibility, metabolism...etc.

Given the environments we move in, including the social environments constructed by ourselves, our individual variations either go relatively unnoticed because they cause little concern, or they create problems. We use the term 'reduced fitness', however it simply translates into an individual's wellbeing or functionality being comparitively reduced. Such variations that are highlighted as such come to be described as disorders, conditions or diseases. There are no strict pathological definitions which differentiate these terms.

As the highlighting of a variation relies primarily on whether it impacts on function or wellbeing in a given environment, describing it as a condition would therefore rely on a subjective determination of 'wellbeing', and would change given a change in environment.

An example of a variation in behaviour which causes conflict in current social environments has been Attention Deficit (and Hyperactivity) Disorder. In a social setting which requires extended periods of attention, the impact of this variation on behaviour could be considered to be an impediment of sorts. Outside of such an environment, it's not.

This leads to confusion where people feel comfortable with a more black-and-white view of a disease and its causes. It's easy to call measles a disease, as it has a single agent and it's difficult to imagine an environment where the individual isn't impeded. Behavioural and neurological conditions are more difficult to understand, as often they are impediments only in a given social environment. In addition, we suffer from a history of dualism, where the mind isn't subject to the same biomechanical descriptions as other organic-based observations.

ADHD studies - as with most neurological and behavioural conditions - are still in their infancy. Behaviour cannot be studied external to the environment it operates in, which further muddies the water. Therefore it's unfair to say one way or another whether ADHD is overdiagnosed. The question should therefore not be about accuracy of diagnosis, but rather the effectiveness and consequences of resulting treatments.

Athon

 

[Paul C. Anagnostopoulos]

Nominated. And I don't do that lightly.

~~ Paul

 

[Liszt]

Nominated. And I don't do that lightly.

~~ Paul

yes, I just nominated this too. Athon is quite the wordsmith

 

[T.A.M.]

Athon;

Interesting and valid comments. I would say though, that if we are to define, as we have to date, what consitutes ADHD, that being a given number of behaviours or symptoms seen together, that are present to such a degree as to impede ones ability to function in ones environment (this being the key to calling it a Disorder), than we have to state, or at least I would state from my personal/professional observations, that the jump to quickly diagnose children with this "disorder" seems to be on the rise, and not necessarily correctly so.

And that is a very long, perhaps run on sentence, but you get my drift I hope.

TAM

 

[Dancing David]

Athon;

Interesting and valid comments. I would say though, that if we are to define, as we have to date, what consitutes ADHD, that being a given number of behaviours or symptoms seen together, that are present to such a degree as to impede ones ability to function in ones environment (this being the key to calling it a Disorder), than we have to state, or at least I would state from my personal/professional observations, that the jump to quickly diagnose children with this "disorder" seems to be on the rise, and not necessarily correctly so.

And that is a very long, perhaps run on sentence, but you get my drift I hope.

TAM

Not really, except in the case of the worried well, they are the ones who want their child to get special education because they got a single 'C'.

As someone who used to do four assesments a day for two weeks and crisis assesments for one week, and who did weekly mental health assesments on a weekly basis for ten years, the issue is usually one of under treatment.

Most people do not seek help when the barn door is open, they seek help after the horse has run away and the barn has burned down.

Now are there people, IE teachers and the like who push a kid to get medicated? Sure there are, but for every one kid who is in that position there are five who are much worse off and have family who don't seek or refuse treatment.

The main issue I have harped upon on this board is that of the 'identified client' syndrome. When kids are in abusive families they tend to act out at a higher level (not at a more frequent level, just a higher level) and so often the poor kid is the one dragged to treatment when the rest of the family is AFU (All Freded Up).

The issue is that in our modern society the skill based repetitive labor of the agricultural era has gone away and the people who can't stay on task have real problem functioning in society.

 

[athon]

Athon;

Interesting and valid comments. I would say though, that if we are to define, as we have to date, what consitutes ADHD, that being a given number of behaviours or symptoms seen together, that are present to such a degree as to impede ones ability to function in ones environment (this being the key to calling it a Disorder), than we have to state, or at least I would state from my personal/professional observations, that the jump to quickly diagnose children with this "disorder" seems to be on the rise, and not necessarily correctly so.

And that is a very long, perhaps run on sentence, but you get my drift I hope.

TAM

I get your drift and agree. Studies of pathology and etiology (as you know) tends to follow a sequence of 'notice a prevalence of symptoms; correlate symptoms with environmental or biological conditions; speculate cause; alleviate symptoms / treat cause'. This is relatively easy when diagnosis relies on simple, dichotomous 'present / absent' criteria. Behavioural conditions are rarely so simple. Yet the danger is that this is often interpreted by the general public as behavioural conditions not being real.

My point is that there is no comprehensive consensus on what list of behaviours need to be present in order to go from 'not ADD' to 'ADD'. It's far from a dichotomy, with an in between grey zone where argument exists. This is without even debating whether there are multiple causes or agents, let alone whether ADD is a single condition or not. Little wonder the debate of how to treat the condition is so fevered.

Without a strong definition of what needs to be observed in order for somebody to be called ADD, the question of whether it is overdiagnosed is impossible to answer. Instead, we should be asking whether the treatments offered in response to ADD diagnosis are actually offering people any benefits, and correlating the successes with something that can be used as a diagnostic tool. That way it becomes less of an issue as to whether somebody has the label ADD or not, but it is useful to observe a symptom and correlate that with a response that will assist them in their current (and, significantly, future) social environments.

As to individuals leaning on the diagnosis as an excuse, that is a totally different issue unrelated to ADD. Any diagnosis can be abused or made useful, depending on the patient's and professional's approach.

Athon