What are your thoughts on A.D.D. ? Are we using it as an excuse for students or is it a valid disorder? And, are we prescribing drugs related to this illness and others too liberally?

It is a valid disorder that is over diagnosed. Ritalin has made a huge beneficial difference in the lives of some people.

Just try living with someone who has ADD and you'll quickly see it's a valid disorder.

Of course it's a real disorder. Some people claim it isn't, but I don't really see where they got off saying things like that. These people are always laymen, meaning they're in no position to debunk a known psychological disorder. Same goes for people who claim depression doesn't really exist. You know nothing about the subject matter. Come back in 10 years after you've got your doctorate, then we'll talk. But until then, leave psychiatry to the psychiatrists. They know what's a disease, and they know how to treat it.

A valid disorder? Absolutely.

Overdiagnosed? Probably. There seem to be "fads" in psychiatry, during which certain disorders are diagnosed a little too quickly. I suspect that the "fad" for ADD and other learning disorders will fade in time. The danger, of course, is that they may then become underdiagnosed, which is a real danger.

Overprescribing? Again, probably. I would be the first to defend the appropriate use of medications in psychiatric illnesses. However, it is no secret that American medicine is quick to prescribe drugs, when a little more caution might be needed.

I recognize it as a valid disorder, but I think it may very well be overdiagnosed in children. With all the talk and misunderstanding of news clippings I wouldn't be at all surprised to find many parents out there self diagnosing their young, active children with ADD or ADHD. The general symptoms are pretty vague, especially when relating it to children. Supposedly behavior assessment is most often handled by a parent or teacher, providing more room for error than may be best.

News of physicians neglecting their basic duties doesn't, I don't think, help to ease concerns of over diagnosis whether it's in regards to ADD or any other illness.

It seems more than possible that there is a vast number of individuals out there improperly diagnosed with ADD or ADHD today. I feel it is no stretch of the imagination that some parent or teacher has complaints with a child's behavior, notifies a physician and comes away with a diagnosis and prescription for ADD, whether or not further tests were ever taken to verify parent or teacher assumptions.

Oh, really? For years homosexuality was labeled as a disorder.

Yes, and Freud thought cocain was a good treatment for mental illness. The feilds of psychology and psychiatry have advanced quite a bit from those days. Yes, homosexuality was once considered a disease. However, it became pretty obvious that you couldn't "cure" homosexuality, and it became clear it wasn't a disease (not to mention the fact that it wasn't damaging to the "patient.") Also, when gay people stopped being ashamed of being gay, there wasn't much incentive for them to try to go straight. But you still do have some gays that are ashamed of their sexual orientation and try to change it, without sucess. ADD (or ADHD), however, is a terrible disease that has harmful symptoms and can be treated.

Your analogy is comprable to saying Relavitity is bunk because pysicists once believed that light moved at c relative to the ether, or that geography is bunk because people once thought the earth was flat.

I don't know a lot about A.D.D. other than what I read/hear in the popular media, but based on that I think it's a valid disorder that's overdiagnosed and overprescribed.

You hit it right on the head, Izdaari.

ADHD may be overdiagnosed, study says

Chapter 3- Is ADHD a Valid Disorder?


Common sense says that a mental disorder, such as ADHD will not exponentially rise over a single generation without some profound change in environment.


The fact is that parents no longer want to deal with the difficulties that arise while raising kids. It is easier to drug them up then to deal with them or to instill discipline.

This is a real problem for some, but it is just a cop out by parents and educators in many cases.

For one I'll weigh in with Amlord - I think that although ADHD is most likely a real condition, it is way over-diagnosed, and the medicalisation of a behavioural problem is not solving anything.

Disruptive kids have always been with us, yet what evidence do we have that kids we could now retrospectively say had ADHD were failed by the behavioural remedies that were used in education and the home prior to the invention of ritalin?

For example, punishment by detention in schools, preventing kids from doing what they want; sending kids to their rooms in the home (in the days before ubiquitous television sets and games consoles, of course - bedrooms are now the preferred recreational site for many kids); and so on. That's without even mentioning physical punishment, which (with some justification) is also out of fashion.

But because the behaviour is now a "condition" which is treated with drugs, rather than just by trying to influence kids out of behaving in that way, everyone has a back door. Prior to ritalin, a boisterous kid (and the vast majority of these are boys) required patience and discipline (self-discipline on the part of the responsible adult, as well as administered discipline on the child). Most adults can remember some occasion on which they were rude or boisterous in class, or when someone else they knew was.

I know I was a complete terror sometimes. Mostly this was just mischief - testing the boundaries to find out what I could or couldn't get away with. I was lucky enough to have been treated with the kind of patient discipline I referred to - if I was rude, I was usually scolded and sometimes punished, such that I learned what the boundaries were. Other kids in my class were more or less disruptive than me; a few never tried anything, others were constantly pushing. One or two didn't seem to be dealt with very well by the usual measures, and perhaps they would have benefited form something like ritalin. However, I am afraid that if behaviour modifying drugs were as routinely available when I was a kid as they are now, that the temptation would have been "if in doubt, prescribe", and I can't help think that this goes on today to a greater or lesser extent.

But besides all that, there is plenty of evidence to suggest that the vast increase in the processing of our food and the widespread, nay, universal use of food additives is at least as responsible for disruptive behaviour in children, yet next to no effort is being exerted to resolve the causes - there's no money in it for drug or food companies, after all.

Lastly, and this might be off thread, I also think that a great many other medical conditions we now routinely identify are over-emphasised (that's not to say they don't exist and cannot be severely restricting) - including such things as dyslexia. At the same time, a lot of other things that can be easily dealt with are tolerated or ignored - for instance, many kids in England seem to have very poor diction, including lisps, "f"s for "th"s, "w" for "r", and so on. No biggie, I know, but it's really easy to solve these - I had all of the ones I've cited when I was little and my whole family became my speech therapists (for years I wasn't allowed to kissed my granny hello until I'd said "round and round the ragged rocks the ragged rascal ran"). I may have been lucky - but it wasn't very hard for them to do once they knew what to do.

Of all the people I knew in school, all the way from kindergarten through college, I can think of one person who could reasonably be labelled as having a behavior disorder. ONE. Even he could concentrate when he wanted to - put him in front of an interesting computer game and he'd be OK for hours - and this was in his mid to late teens, not as a young kid. Most kids have trouble sitting still from time to time. Most kids act out. The point has already been touched on here - it has become easier to put kids on drugs than it is to discipline them and figure out why they are having trouble.

I have no problem accepting that the condition now known as ADD/ADHD is real. But there is no way that it is as common as popular medicine wants us to believe it is. I have read stories where as many as 25% of kids in a class have been on Ritalin and/or other drugs. Try to find the logic in that. A quarter of kids in a class are "sick." It just doesn't make any sense.

I have an eight-year old stepdaughter who is most certainly ADHD. Her mother and I spent years trying to discipline her, modifying her diet, teaching her good Christian values, and trying herbal remedies, to no avail...it got to the point that her school wanted to kick her out of KINDERGARTEN!.....she was so incredibly disruptive, the teacher simply couldn't teach, she would routinely have to send her down to the office. These were much of the same problems she had in preschool... on top of a severe aversion to any kind of social activities.

Finally, at the bidding of the private school she was attending, we did have her diagnosed, originally placing her on ritalin, now she's on concerta, and I am not kidding when I say I will NOT take her out of the house without being medicated...its the difference between night and day.

In the mean time, her biological father has been diagnosed and is medicated (this may explain why he never made it past the 8th grade), and is finally gainfully employed (for 3 continuous years now!)

Our other children, which my wife and I have together, seem to be fine, and well adjusted, with no hint of ADD, or ADHD.

If you were to ask me if ADD, or ADHD is valid, my response would be "absolutely" and if you needed further proof, I'd send my daughter over to your house for a week. Conversely, I do believe that in some cases it's not needed, just like anti-depressants were over prescribed in the mid-90's...hopefully as we learn more about this disorder, the mis-diagnosed will diminish.

Your argument is conjecture. There have been quite a few profound cultural changes of the last 30 years or so, and less discipline is only one of many. Do you have any proof that children that live in strict families have lower rates of ADHD or ADD? And even if they did, do you have any proof the extreme discipline is a better cure for ADHD or ADD than Ritalin or any of the other various treatments that psychiatrists prescribe?

This disorder is being "diagnosed" by parents, teachers, child care workers, over the phone by doctors, by guidance councillors...It is no wonder in an era where drugs are directly marketed to the general public that the general public cries out that they (or in this case, their children) NEED them.

The stats show that boys are more prone to be "diagnosed". I submit this is because boys are more apt to be difficult to "control", that they push the limits more than girls do.

The stats also show that higher incomes lead to increases in diagnosis. Again, the parents who are more likely to know the effects of ritalin on "controlling" their kids' behavior.

Of course, it is conjecture. As another poster said, I personally knew ZERO people on Ritalin during my school years. This isn't to say that there were none. But today, millions take this drug on a daily basis, and one needs to wonder why the sudden increase.

That's right. In fact, the disparity is HUGE. Boys are 8 times more likely to be diagnosed with ADD or ADHD.

http://www.drz.org/asp/conditions/ADD_ADHD_LD.asp

I actually agree on this one. Ever since they made it legal to advertise drugs by saying what they supposedly do, people are going out and buying multitudes of drugs they don't need. However, this still doesn't mean that ADD isn't real, or that most people who are diagnosed don't really have it, or that strict discipline cures ADD in an effective way. Isn't it possible than ADD has existed forever and that begin ridiculously strict just made them repress it, not cure it?



Again, this is conjecture. Men are much less likely to be diagnosed with breast cancer than women. Women are much less likely to be diagnosed with color blindness than men. Both of these diseases obviously exist. How do you know that ADD isn't just a disease that boys are more likely to get than girls? You don't.




You think that because people are poor, they're so stupid they don't know about Ritalin?

While I agree that ADD and ADHD are likely over-diagnosed and often misdiagnosed, we should remember that partly this is a natural occurance when new diseases are discovered. Zero people had Parkinson's Disease until the parameters of it were classified and codified. The following years, there was a huge surge of people who had Parkinson's.

So it isn't necessarily true that "all of a sudden" tons of people have ADD and that makes it less believable. Before we knew what heart attacks were, or what caused them, people didn't have them - they merely dropped dead. I think it's important to remember this point when discussing "new" diseases.

An 8 to one disparity in diagnosis between the sexes is very significant.

More women are diagnosed with breast cancer because women have breast tissue, and men usually don't. More boys are color blind because red-green color blindness is a sex-linked characteristic transmitted through the male chromosome.

ADD isn't a sex-linked trait (at least not on a chromosomal level).

And you know this how? How do you know there isn't a certain gene (or genes) that makes one more predisposed to having ADD on the X chromosome? I'm not saying there is or isn't, but it isn't any more or less likely than the other reasons put forth to explain the discrepincy between boys and girl diagnosed with ADD.

I have to agree with amlord on this one - absolutely. In fact, I'm only willing to accept that it may be a genuine disorder - I have yet to see any complelling evidence. I must admit, though, I have a lot less faith in the psychiatric industry than many.

My partner and I raised two "difficult" boys. I'm certain that, had we subjected them to psychiatric examination, they would both have been diagnosed has having ADD - or worse. You know what? With a bit of care and attention, with a bit of time being spent with them, they both turned out fine. No medication required.

Had Ritalin been as widely used forty years ago as it is today, the sixties would never have happened. We are "curing" nonconformity, we are "curing" rebellion, we are "curing" freedom. Does the word soma ring any bells?

You asked a fair question, which led me to think….
The ratios are reasonable. A sex-linked recessive gene might yield about a 1 to 9 ratio of boys to girls. Of course, this would require us to lump ADD and ADHD together, assuming they were identical diseases.

The girls affected would inherit the trait from both the mother and father. The mother would be either a carrier or exhibit the trait, and the father would HAVE to exhibit the trait also for the female to be affected. The boy would not be affected by the father at all, but would have a 50 percent chance of exhibiting the trait with either a carrier or homozygous affected mother. The pattern of inheritance would be more obviously manifested in the few females inheritors, as their trait would be completely dependant on the genes passed on through the father.

The formulas, using various genetic possibilities, would come out something like this:
Xa=trait X=normal
XaX=female carrier XaXa=female affected XX=normal female
XaY=male affected XY=normal male

(affected father, carrier mother) XaY x XaX= XaXa+XaX+XaY+XY
(affected father, normal mother) XaY x XX= XaX+XaX+XY+XY
(both affected = 100 percent affected children)
(normal father, carrier mother) XY x XaX = Xxa + XX + XaY + YX
(normal father, affected mother) XY + XaXa = XaX + XaX + XaY + XaY

So, I looked online to determine if there is a pattern of inheritance. ADD and ADHD show a definite hereditary characteristics, but is it a sex- linked trait? Apparently not
ADHD


Also, just a cursory glance at about a thousand other sites indicates that the medical community at large agrees that this might be an overdiagnosed disease.
Here's just one:
http://www.aafp.org/afp/981200ap/conhigh.html

Yes, almost everyone agrees it might be an overdiagnosed disease. That doesn't mean it is, and it certainly doesn't mean that lack of discipline is to blame. You can't just read this stuff into things without proof.

And that study from the University of Dublin is far from conclusive, and you know it.

Just out of curiosity, Rattlesnake, why do you seem anxious to determine that ADD/ADHD is not over-diagnosed? Or am I getting the wrong impression from your posts?

Here's an interesting take on Attention Deficit Disorder.

One thing that's missing for me in this debate is a description of how ADHD and the other newly recognised conditions in the same spectrum manifest themselves in adults.

I'm such serious behavioural problems aren't things that one just "grows out of".

Are we talking about constant repeat petty criminals, fathers of children from multiple mothers, the serially unemployed, etc? Or what? If so, perhaps ADHD et al. have much wider social and political significance than getting Johnny to sit still in class.

I believe that the same debate applies for A.D.D. as for other mental illnesses. When you diagnose an illness too frequently, and likewise, prescribe a medication with too much enthusiasm, it takes away from the validity of those with true mental illness, such as myself. There has been a recent push for prescription medications in this country--you can simply watch television for a short period of time for the many, many commercials that are being circulated. A.D.D is a serious condition, but I do think that physicians are too quick to prescribe medication for it, especially in children. In my opinion, it is not necessary to give an 8, 9, 10 year old child medication for a supposed "illness" that may very well be just a part of growing up.

My brother is diagnosed ADHD. He used to take ritalin but it really dulled out his personality so we took him off it and they put him on adderall which had less of that effect. He only takes it in the mornings before school, as opposed to several times a day. If I choose to go to the doctor I'd probably be diagnosed ADD as well, as I exhibit but have learned to control most of the symptoms of it.

Here is a GREAT article I found on the web some time ago that I think explains the ADD situation perfectly (it also goes into how it effects adults, not just children):

http://www.add.org/content/abc/hallowell.htm

I would say that it is definitely a valid disorder but that immediately jumping to medications is not the best mode of treatment. There are alternative ways to cope with ADD and I think that only a limited number of ADD children/adolescents actually need to be mediated. I'm not going to even get into the misdiagnosed children. I happen to have 2 friends (musicians) who are diagnosed ADD and both refuse to be medicated for it. They both cope pretty well without being medicated and are happier not being drug dependant. Attention Drugs (likened to speed, that is what ritalin is essentially) can really effect the personality of the person taking them, not always in positive ways.

I agree with you erratic. I have also heard that some medications for A.D.D. hinder creativity in those who take prescription drugs.

I don't really see what it has to do with the debate, but I get seriously annoyed with the idea that scientists don't know what they're doing and we should all just rely on "common sense" to solve problems. It may very well be over-diagnosed, but you can't reach that conclusion by the reasoning that a lot of people offer. You can't just say "no one used to get ADD, so that means if we discipline our kids more it will go away." There's absolutely no proof to that effect, at least that I've seen. I trust psychiatrists to do psychiatry better than laymen. Why wouldn't you?

I can give you the example of my stepdaughters father, who was recently diagnosed with ADD -

#1. I should add that he was a foster child since the age of 8, however, so where his brother's and they have all turned out fine. He didn't finish school, dropping out at about 8th grade. He has a chronic lying problem...when I say chronic, I mean, that he doesn't know he's lying...He'll actually think he went to college, or he'll think he lived in California.....A story my wife told me had to do with her helping him get his G.E.D., and she'd give him the money to go to school, and he'd forget where he was going, and what the money was for, and instead buy audio equipment at the pawn shop. He couldn't keep a job, because he couldn't remember what he was supposed to be doing. He'd spent time in jail for forgetting to pay fines, and once, he was supposed to go and get new tabs for his car, and figured it was easier to take the neighbors tabs (which he was subsequently arrested for and did a weekend in jail). Forget what weekends he had visitation.....Very absent minded....he had an apartment, and left his motorcycle there after he'd moved out..didn't leave a forwarding address....eventually it was impounded, because nobody wanted it....he just simply forgot it. Now that he's been diagnosed, he's held the same job for over 3 years, and gets paid quite well for manual labor, is working toward he GED, doesn't have problems remembering bills and such. He is on the straight a narrow, so to speak, since being proscribed Ritalin....ask him, and he'll say it's like a fog has been lifted, it's changed his life.

I think you give psychiatrists too much credit. They have a very high suicide rate, when compared to the rest of the population. When compared to other physicians, they have the highest incident of both drug abuse and suicide.
If 'common sense' is causing the general public to off themselves at a lower rate than the very physicians who specialize in treating the problem, I consider it a victory for common sense.

This is exactly the attitude I was talking about.

First off, your argument means nothing. Regardless of their suicide rate, psychiatrists still know more about psychiatry than anyone else, because they're psychiatrists. White males kill themselves more than any other group, and they also have the highest rates of drug use. Does that mean that that white males are unfit to be trusted with scientific research? Of course not. Try to avoid straw-man ad hominems like that.

Here is what scientists, including psychiatrists and psychologists, do to determine the truth: they observe a phenomenon, make a hypothesis, run experiments, examine the data and reach a conclusion. What you do is observe a phenomenon and make a hypothesis. Scientists back up their conclusion with proof, you make conjecture, using the occasional pieces of data. They obviously have the better case, because it's backed up by research. They know quite a bit about their field, and assuming you're not a psychologist/psychiatrist, you know very little. How do you respond? With a worthless ad hominem that has nothing to do with the subject.

My sister is a psychologist, and every day she goes in and either does research, writes papers or gives lectures, all on the subject of psychology. She doesn't work on ADD, but there are some people who do. Every day, they go in and research ADD. Can you say the same? They've reached a conclusion, and though they may possibly be wrong, it is not your place to say they are without data to prove it. Yes, ADD may be overdiagnosed, I might go as far as to say it's probably overdiagnosed. But until you have a great deal of scientific data to back up that opinion you can't say with any level of certainty that this is the case.

If I go to a dentist, I expect him/ her to have a fairly good set of teeth. If I go to a weight loss specialist, I would expect him/ her to be fit, and not offering advise while gorging on a ding dong and pointing to his credentials on the wall. I call that direct, empirical evidence of credibility. You can call it ad hominem, which is, by definition, what you are doing to ME in your response to my post.

So, by your argument, white men should not become psychiatrists because they have a higher rate of suicide than other groups, right? Do you really, honestly think that because a certain demographic has a higher rate of suicide, that means that anyone from that group is completely unqualified to give psychiatric advice? People who have suffered from depression are much more likely to commit suicide, but formerly depressed people often head up depression discussion groups to help people cope. Is that a terrible idea?

Also, it was not an ad hominem, because it actually had a bearing on the issue. You say you know better than the psychological community because ... well, just because. I content you don't. How is that an ad hominem?

http://www.nizkor.org/features/fallacies/a...ad-hominem.html




(emphasis added)

Ad hominem is an attack on the person presenting the argument rather than the argument itself. Your sole foundation for validating the (massive) diagnoses of ADD, in the post I was responding to, was the premise that ‘psychiatrists are scientific, they go to school for a long time so they must know what they’re doing’. It is completely within context to challenge that assertion. Since the credibility of the mental professionals was the very foundation for your argument, (IMO) their track record indicates an uncertainty regarding the credibility of their diagnoses.

Your response to my post was limited to ‘scientists know because they are scientific, and you don’t because you’re not’ (you assume). I am unable to come to any legitimate conclusion or hypothesis based on the plethora of information I have found, some of which I’ve posted, because I’m somehow not scientific enough. I have never asserted that I know better than they. I simply question the enormous number of children which are being drugged and ostensibly mentally ill, and there are an abundance of medical professionals which do as well.

Have psychiatrists been wrong in the past? Extremely.
Do psychiatrists have a disproportionate number of abnormal mental conditions when compared to the rest of the general population? Definitely.
Is there a profit incentive for psychiatrists to diagnose a disproportionately large number of children with ADD? Absolutely.
Is ADD widely suspected by the medical community to be overdiagnosed? Without a doubt.

Just MHO.

Continuing this discussion would just be argumentative. Feel free to believe that it's completely impossible that ADD is not greatly overdiagnosed, continue to believe that psychiatry is bunk because some psychiatrists kill themselves, and continue to believe you're just as qualified in the field of psychiatry as someone who's gone to 10 years of college to get a doctorate degree. I know that I'm not going to change your mind about it.

It doesn't seem to me that MrsPigpen is denying that A.D.D. is a real disorder. The thought that it is over-diagnosed is hardly uncommon within the medical community, after all. Dr. Oliver Sachs, in his book The Man Who Mistook his Wife for a Hat, speaks of the "discovery" of Parkinsons, and later, Tourette's Syndrome - that how once the signs and symptoms of Parkinsons were identified, there was a distinct tendency to see signs of the disorder in every other person in the street.

The big problem with ADD is that its symptoms are in many ways exaggerations of normal functions, rather than distinct abnormal symptoms - they are more different in scale than they are in substance. Doctors and psychologists are people before they are scientists, most of them, and they are as susceptible as anyone else to problems of perception, and to judgemental errors, even within their specialty.

Disorders and diseases that are identified by a collection of symptoms rather than by a yes/no test are difficult diagnoses. If and when such a test is discovered for A.D.D., this will become a largely moot issue.

Yet I am not disparaging the profession, not at all. In diagnosing ADD in one of my children, for example, I might seek a second or third opinion, but I would also defer in most every way to the greater knowledge of the physician or psychiatrist when it came to diagnosing the disorder.

As I said before, it was the logic, not the conclusion, that I was contesting. Your post is highly more convincing than MPP's argument that because psychiatrists have a higher suicide rate than the general population (which could be caused by any number of things) that they were somehow unqualified to give any sort of psychiatric advice, and that she was a much better source of psychiatric information. As I posted before:

I challenge you to find where I asserted that I was a 'better source of psychiatric information'. I stated that you gave the psychiatric community (and, I think, the entire medical community in general) too much credit in your assumption that they cannot be questioned by anyone outside of that establishment.

Right on MrsP! I fully agree with her on this.

ADD is a valid disorder but yes it is probably overdiagnosed (more when it first became faddish in the late 1990s than now).

quark made an excellent point twice now which I think sums up the ADD issue pretty well:

Add hefty diagnostic and treatment fees - as well as kickbacks from pharmaceutical companies - into the formula and you've got a situation begging for overdiagnosis - and this is not just restricted to ADD or even psychiatry.


I'm not disparaging the profession either - but I am disparaging many of its practitioners. They are every bit as motivated by greed as anyone else and - having spent more money and years on their profession than most others, with the anticipation of a well-paying practice at the end of it - perhaps even more so. The fact that someone is a doctor or a psychiatrist does not make them any more ethical than anyone else.