ADD (No spam)

[Ode to a Grasshopper]

As the topic arose in the Style and Children thread, and to avoid spamming it up, here is a thread for discussing ADD/ADHD. I don't know a great deal about the condition, in spite of having been born with it, but if anyone has any questions I'll do my best to answer them.
So, to answer HLD's questions from the previous thread, I'll recap the posts relating to the topic and then go about answering them.

Originally posted by HighLordDave

This is because our society denies personal responsibility. This is why so many kids are on Ritalin and other medications; the parents don't want to take responsiblility for the fact that their child misbehaves and lacks discipline. Ritalin tells parents that their kid has ADD, not that the parent didn't give them a swift slap on the rear when they needed one.*

*Not that there isn't any such thing as ADD; there is, but it is my opinion that ADD is something that is overdiagnosed and overmedicated.

Originally posted by Ode to a Grasshopper
There is indeed, I have it and in my case it simply shortens my concentration span. I am in fact one of the more quiet, courteous people around my age that I know (in no small part due to my parents and how I was raised), yet I have this disorder that is widely associated with problem children.

To be honest, though, without the medication (dexamphetamine sulph) I used to take I wouldn't have got through high school, the intensity of the last 2 years would have been too much for me to cope with without a normal attention span, despite being unusually bright (as I suspect are most of us here at SYM) and having a good maths and english ability.

Originally posted by HighLordDave
@Ode to a Grasshopper:
I don't mean to hijack this thread to be about ADD, but it is my experience in the US that ADD is something that is overdiagnosed. Is that the case in Australia?

When I was in school, there was no such thing as ADD (although I certainly knew kids who showed its symptoms). Now, if you go to a lot of pre-schools and kindergardens, it seems that 40%+ of the kids are on Ritalin, a number that seems to be unreasonably high.

I believe the reasons for the widespread diagnosis and medication for ADD are twofold: First, there is the thing about denying personal responsibility (see my post above). Second, if you have a child diagnosed with ADD, in the US that child is entitled to a government stipend to help cover their "disability".

I believe this overdiagnosis detracts from kids who truly suffer from ADD. What is your experience?

. . . This subject may belong in a separate thread, but I'm interested in what you have to say about this.

That's about it, reply will be in the next post.

[Craig]

I have ADD as well.

[Bloodmist]

call me stupid but... what's ADD. Not being able to concentrate for very long or what?

[C Elegans]

ADD is Attention Deficit Disorder, a milder version of the more well known ADHD, Attention Deficit Hyperactivity Disorder. It is also important to know that the ADD diagnosis is not accepted worldwide.

In an international perspective, we have very restrictive regulations of medications of all sorts, from antibiotics to psychopharmaca. ADHD and other child neuropsychiatric diagnoses were long underdiagnosed here, as elsewhere. However, we do not have the problems with overdiagnoses of these conditions as the US and also the UK is known to have. Overinclusive diagnosis criteria, diagnosis often made by non specialists or only one specialist and without proper clinical assessment is common in the US, and unfortunately often followed by medication, since the US medical culture is to solve most conditions with pharmacotherapy. I know American people, both adults and children, that have been diagnosed with ADHD after only a couple of meetings with a doc, and one or two tests. That is not how it's done here.

The issue here is IMO twofold: First and most important: how good is it to start an lifelong drug treatment in children, affecting transmission systems that we don't know even the most basic things about? Studies in rats and port mortem studies of human brains, show that prolonged medication with any substance that changes neurotransmission, can have irreversible side effects. Is it worth this if there are other ways to solve the problem? Or if the child actually doesn't have a problem in itself?

Which leads us to the second question: if disturbances in ability to focus and allocate attention are so common as the US diagnosis system suggests, should it really be classified as a disorder? Studies suggest that almost half of all kids would have some kind of neuropsychiatric disorder if looser criteria were applied in Sweden. So I think we should ask ourselves if it's really the child who has a problem here.

Many children suffer from different neuropsychiatric conditions and disorders, and they should get the best possible treatment there is, pharmacologically and otherwise. But a good treatment requires a proper diagnoses, and a proper diagnosis must be based on a proper assessment.

And I'm sorry to say this, I'll edit it out if somebody is offended, but the FDA are ***holes, there is no other health institution in the world that has let out so many dangerous drugs on the market in an immature state, without proper testing, because of pressure from commercial interestests (read: the drug industry). For those of you who don't have a lot of contact with or insight in the FDA, be happy, it's nauseating.

[C Elegans]

Here are the diagnosis criteria from DSM-IV. For ADD, just remove the hyperactivity component.

Diagnostic criteria for ADHD

A. Either (1) or (2):

1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

- often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- is often easily distracted by extraneous stimuli
- is often forgetful in daily activities

2. six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- often has difficulty playing or engaging in leisure activities quietly
- is often "on the go" or often acts as if "driven by a motor" often talks excessively

Impulsivity

- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia , or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).


Associated Features

- Learning Problem
- Hyperactivity


(All the criteria A-E must be fulfilled.)

[HighLordDave]

It is my opinion that ADD is overdiagnosed in the US because we are a pill-popping culture. Every problem has a drug which you can take and it will make your problems disappear. This is why there is such a boom in "diet" drugs; rather than change our eating habits and exercise more, we want to take a pill and lose all of the weight. I believe this also to be why sales of Viagra­™ are booming; rather than blame lack of desire or ability on poor sexual performance, we take a pill and everything is back to "normal".

Similary, I believe that many people name their problem ADD when in fact their kid is out of control because their parent allows them to run around unchecked, instead of suffering from any sort of neurological or psychological disorder. As I've said before, it's not that I don't believe ADD exists, it's that many people who claim their kids have it either don't want to admit they don't know how to set and maintain boundaries for their kids or they want some drug to calm their child down instead of putting forth some effort at being a parent.

Plus, there's the part about being able to collect a disability check every month because their kid suffers from ADD.

I know there are some people here who work in the medical field and was wondering if they have the same opinion that I do, or if I'm just an insenstive idiot.

[gnomethingy]

Lemme say this....

Ive been diagnosed with 'Add'

and I say, Bollux

When I cant concentrate its solely becouse I dont like what im doing or I want to be doing something else,

I make mistakes etc becouse I shred through the things I dont like in order to be able to do the things I do like faster....

Its not a disease, its personall choice... I couldnt give a dos weather or not people like my work / spelling whatever, im just spewing it fast to see the end result / do something better...

Thats my take, I think allot of people are falsley diagnosed with medical problems when it just so happens that there methods and there general state of mind leads to something that looks alot like it

[smass]

There is no doubt in my mind that ADD is a real problem - a real "disease" in the scientific sense. However, the current criteria for diagnosing it seems to be a bit flawed and over-broad.

"often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities"

I just took this one example from CEs post - come on what kid doesn't this describe? The rest of the criteria are just as generic. This goes to HLDs opinion about discipline. Why are so many more kids recently diagnosed with this disease? - they have been allowed to act this way by their parent(s) and teachers. Discipline would probably cure a good 50-75% of the cases. But what else can "cure" them? - Drugs. Lets look at the results:

Discipline and self responsibility: makes no money for anyone.

Drugs: keep the Doctors and Drug Companies in their Mercedes.

Gee - I wonder which solution the medical field will get behind?

@Ode - I don't know your personal situation and above is my opinion - it is not directed at you or anyone else with the disease - I am interested in the proliferation of diagnosis of this disease - my intention is not to make light of the real cases that I do believe exist.

[smass]

One more point - I don't put all the responsibility on the Doctors - Parents are equally to blame for looking for an easy solution - a pill that will make all their problems go away - and avoid their having to work to raise their kids and take a good look at themselves and their parenting skills.

Want to find a real cause for the high ADD rate - take a look at the number of parents working and the number of kids in Daycare. It is no coincidence that the percentage of kids in daycare has grown as exponentially as the ADD rate. We as a society need to face this fact.

[Dottie]

Originally posted by smass

I just took this one example from CEs post - come on what kid doesn't this describe? The rest of the criteria are just as generic.

If you read the whole post you will find that the criteria in total was far from generic, even if more than one of the specific points was.

[smass]

My point was not that CE's information was generic - rather that the criteria for "diagnosing" this disease is so generic and all encompassing that a case could be made for upwards of 90% of the worlds population to have ADD.

That is bad because:

1. 90% of the polulation does not have this disease and is smells like a sales pitch for drug companies.

2. The people who really do have the disease are negatively affected because the cures are lost to the drug marketing juggernaut.

If CEs post is accurate and this is the criteria for a doctor diagnosing this disease (and I am confident in reading many of her posts in the past that it is) - then the criteria is over broad. period.

[Dottie]

Originally posted by smass
My point was not that CE's information was generic - rather that the criteria for "diagnosing" this disease is so generic and all encompassing that a case could be made for upwards of 90% of the worlds population to have ADD.

I understood that, my point is that you are incorrect in assuming the criteria generic. For example some of the points listed first is very generic, but if you read above them it says:

1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level

Now, 90% of the population can hardly have symtoms inconsistant with developmental level... Or?

Futher down:

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

I cant be sure about you, but this does definatly not hold true for any significant part of my social contacts.

[smass]

I am sure that your social contacts are very highly developed . To go in a different direction - the behaviors that are discussed also seem to be related to stress.

In your clinical opinion CE - is there a chance that the increased diagnosis of ADD is a reflection of the elevated stress levels that many children seem to live under? It would seem to me that this would be the case - and if it were - wouldn't that fact mean that factors in the household - such as discipline and parental interation - could be the cause of said symptoms?

What I am driving at is that I believe that prescribing a drug to control the behavior of a child who exhibits these symptoms may be overkill - and indeed mask the true sorce of the problem? Much like cold medicine simply treats the symptoms and by and large does nothing to cure the ailment - prescribing drugs to mask the symptoms of ADD seems to be a short sited and potentially dangerous practice. Certainly children with extreme cases may need sedatives - but are drugs really a responsible answer to the real problem here?

[Chanak]

Normally drugs are administered by psychiatrists in order to address physical sources for behaviors. I believe everyone here is touching upon one side of a multifaceted issue that has no simple answer. It was my experience, many years ago, that a diagnosis was not reached until certain standards had been met and satisfied.

Smass has a good point, Dottie, in illustrating the proliferation of medications here in the United States. While I certainly would not consider CE's post detailing the guidelines of diagnosing ADD & ADHD vague or too generic, what is often missing here in the US is a thoroughness and attention to detail on the part of the physicians and the parents of children alike in the process. I believe CE pointed that out in her post, and I agree completely. Unusually high numbers of children these days are on some sort of medication here in the US; contrast this with 25 years ago (during my childhood) when it was almost unheard of. HLD raises something that I believe is at the heart of all this: the parents of the children. 25 years ago, children spent more time with their parents than they do now. Personally, I equate the current condition of children today to the current state of their parents today. Very few have chosen their children over their careers, and it shows.

[Dottie]

@Chanak: I didnt say anything about US drug culture, overdiagnoses or anything else of that nature, I merly pointed out that the criteria posted was not applicable to a majority of children. This was my only point.

[Ode to a Grasshopper]

@smass-no worries from my end, I decided a long time ago not to get worked up over something I have no control over, and for the most part I've stayed true to that goal (though the end of high school exams got me a bit irritated). Besides that I can cope okay without medication etc on a day-to-day basis, it's just during situations where sustained concentration is needed that I need to 'dope myself up', as it were.
Apologies for getting back to everyone so late, my internet was being a pain on Sunday and I didn't visit GB yesterday.

In my case I have ADD, as opposed to ADHD, which meant I was diagnosed quite late (at the end of my primary school years) as no-one suspected I had the condition, seeing as I was a quiet student in primary school. By that time my study habits had become somewhat lax, though I have since managed to overcome that. It simply means I can't concentrate as well as most people without medication, though there are some other disadvantages, such as an abysmally slow writing speed (it is this that gives me the most frustration, especially during exam situations), and while I have a natural ability for languages/english/maths, my ability for learning languages is somewhat suppressed. As a child it also caused me to have poor hand-eye coordination, which thankfully I have outgrown. I have been diagnosed as being unusually intelligent (I'm so good, I'm so good, etc ) which fortunately is not affected by the ADD and which has been vital to getting through high school and into University. I also have an overactive imagination and tend to daydream a lot, which is another area the medication helps keep under control.
Unfortunately, as dexamphetamine is a speed derivative (not addictive, thank heavens!) I get all the side-effects of speed, ie. suppressed appetite (I never have been a big eater, my weight used to get down to around 52kg during the school term, and my face would go skeletal in appearance), occasional mood swings and difficulty getting to sleep. I have been off the medication this year, and my weight and general health has improved by far, though I'll need to take it again for University next year.

To answer HLD's question, IMO ADD (and more particularly ADHD) is overdiagnosed (here in Australia, at any rate). Whilst many children probably have the condition, not all of them have it to the degree that medication is needed. The fact that it is overdiagnosed detracts from those who have the condition to the extent tghat it becomes a real problem, to my mind, especially when 'current affairs' TV shows do specials on how it's all so overdiagnosed, and children are supposedly selling the drugs in the playground etc etc. In Australia there is no disability payment if a child has ADD, that I know of.