[eruditely]

Why don't you read a fucking ADHD support forum and wonder whether the suffering caused by poor executive functioning/nervous system disorder is real?

Why didn't they mention how many more times you are likely to die in a vehicular accident than non-adhd users?

http://scholar.google.com/scholar?start=10&q=adhd&hl=en&as_s...

Google scholar for ADHD, why don't you realize that these ADHD articles are more akin to anti-vaccination articles?

[DerpDerpDerp]

Your response doesn't actually address the article, which acknowledges that ADHD is a real condition, but suggests that fewer than 1 in 5 boys have it, and that a large number of misdiagnosed cases is bad, considering that they're given serious drugs because of it.

In fact, the only number it suggests as being inaccurate (based on an old study) is 25% of cases - that 1 in 4 cases is misdiagnosed. However, given the number of total cases, that means something like 5% of boys are being given serious drugs for potentially no reason.

I think that deserves serious consideration, and not your knee-jerk, strawman response.

[gress]

Also it's worth pointing out that if 1 in 5 boys have it, it's not a disorder. It's part of the normal range.

[joeyo]

I'm not sure if it's that black and white. Roughly 25% of deaths in the US are due to heart disease. Should we not intervene because heart disease is part of the normal range?

[amirmc]

I agree that it's probably not that black and white but a comparison with heart disease isn't a fair one.

The grandparent post does make a point. If such a large proportion of the population has a 'condition' is it really a condition or perhaps just how we (as a species) are? Especially in the case of something that's psychiatric/psychological.

For example, I've heard estimates that around 10% of the population is homosexual and for many years people wanted to 'fix' them. Around 10%-12% of people are left-handed and (I believe) that historically this was also something that people tried to 'fix'. I doubt many of us think twice about these anymore.

To a sibling comment that suggested what if 1 in 5 boys were born deaf, I'd say that the world would be a vastly different place. So different that we may not even entertain such a question. If, instead, 1/5th of boys were beginning to be born deaf, there would be a medical emergency. Unfortunately, in the case of things like ADHD it's difficult to know if we've always been this way or if there's really been a change.

[aianus]

Being gay or left-handed doesn't inherently impact your quality of life. Not being able to concentrate on anything does. So even if it were part of the normal range we should work on fixing it, like we do for myopia.

[amirmc]

Being gay or left-handed doesn't inherently impact your quality of life.

It does if everyone else is telling you that you're abnormal (and need to be 'fixed'). That was the point of using those examples.

Not being able to concentrate on anything does.

Only if society has defined as valuable the ability to do only one thing, without distraction, for whatever period of time. Therefore, anyone who cannot do this must be 'broken' somehow.

So even if it were part of the normal range we should work on fixing it, like we do for myopia.

The first part of your sentence doesn't make sense. If it's 'normal' then by definition it isn't broken (and therefore doesn't require fixing). For the myopia example, most people 'fix' it by wearing glasses or contacts, which are non-permanent and do not mess with brain chemistry. Indeed, some people I know with myopia only bother with glasses when driving and cope just fine without for the rest of the time. Of course, measuring the degree of myopia is very easy so drawing a line between 'has some difficulty' vs 'severely impaired' is a lot more clear cut. In one case, we can consider glasses as an augmentation to something that is normal, whereas in the other we've fixing something that's broken.

I'm not suggesting that ADHD isn't a problem. Merely that we should exercise some caution before we label some things (people?) as broken, when perhaps they are not.

[gress]

You're affirming the consequent.

[pantalaimon]

What is a normal death?

[rtpg]

three-quarters of Americans need vision correction, does that make it 'normal'?

[nsxwolf]

We need vision correction to meet a universal standard of visual acuity in the modern world - so that we can all read the same road signs, etc.

Normal vision could be interpreted as a range much larger than our arbitrary standard of "perfect", 20/20 vision.

[gress]

Yes, and well understood. Do you understand ADHD?

[rtpg]

As someone who has gone through tests and been diagnosed with ADD, I think I understand the frustrations, and it definitely does not "feel" normal.

Not being able to hold onto a thought for more than 3 minutes, or having to deal with potentially being distracted by every little thing that happens around me does not feel like the normal state of affairs. Trivial tasks can take me hours instead of minutes in some situations.

Unfortunately I'm currently in a country that doesn't allow me to get medication for this (and previously I was in a country that believes that ADD/ADHD magically disappears when you turn 18), but I still have good memories of how much it helped me get through middle school and high school (I went from almost never finishing my math homework to being able to finish everything in class in only half the allotted time).

[gress]

For sure - there is a wide variety of human experience, and each of us understands our own. By understanding ADHD, I was talking about the causes and the nature, not the experience.

If drugs are the only way someone like you can lead a happy life, then you should be able to use them.

[jonah]

Did 1 in 5 have it 50 years ago? 100? 500? If not, why now?

[chimeracoder]

Would you say the same if 1 in 5 boys were born deaf?

[harshreality]

Can deafness be treated in any other way?

What effort is being made to determine whether the etiology of ADHD is primarily biochemical (chemical/genetic), or primarily psychological (environmental/human-interaction)? Drugging to counteract ADHD symptoms makes sense only if it's the former.

[torkins]

So given that ADHD is, in actual fact, a neurobiological diagnosis, not a psychological diagnosis, then I guess you're stating your support for treating it with drugs?

[harshreality]

Neurobiological sounds like psychological to me. Unless you're saying doctors are measuring things like dopamine activity or doing brain MRIs to diagnose ADHD.

There's no good evidence that ADHD is not the result of psychological conditioning. For that matter, even if you measured abnormal neurotransmitter activity or brain scans in suspected ADHD patients before diagnosing them, if you looked at animal psychology studies where pathological behavior has been induced by conditioning, I'd be surprised if there weren't abnormal brain scans and neurotransmitter activity there, too. The neurochemical/neurophysical measurements that might provide "evidence" of a non-psychological etiology are invalid if those physical aspects of the brain are themselves affected/modulated by neurological conditioning/development.

If your solution to any problematic "neurobiological" symptom that responds well to a certain drug is to prescribe that drug, because if it responds to a drug it must be a chemical/genetic problem, then everyone will be on a drug eventually. Probably several.

[gress]

What are the biochemical markers for ADHD, and how are they tested for during diagnosis?

To my understanding, they are not, which makes ADHD a psychological condition.

[gress]

Yes, unless there was evidence of a contemporary cause, in which case I'd investigate it.

Have boys changed, or has society?

[epx]

Chebychev inequality!

[eruditely]

Your response is vague apologism for irresponsible journalism justified on a minor technicality. The articles is so stupidly charitable to it's own worldview(in the sense of lying) and omitting so much from the other side that it is ridiculous.

You are wrong to think that these people deserve "serious consideration", when the article is written itself to produce knee-jerk reactions "The drugging of the american boy....", as if we had IV Heroin plugged to these kids. Article allows for the opposition, most people who have random opinions about ADHD for no apparent reason other than to have an opinion.

http://www.ncbi.nlm.nih.gov/pubmed/23382575 (Is ADHD a Risk Factor for High School Dropout? A Controlled Study.) tells us that " Conclusion: Participants with ADHD were significantly more likely to repeat a grade"

Do you know the cost of high school drop outs or grade repeats to society? What about to the kid, who suffers massive self-esteem loss and under-values himself? Why is the author not more responsible? The modern era brings us new journalism-contrarian-chic, stylstic articles that irresponsibly lend fuel to very harmful world-views(such asADHD is not serious)

What drugs, exactly, and to which boy? Is the cost of not-treating much greater than the cost of treating? The article is merely an appeal to pop-trash trendy world-views, and does not deserve much of a response at all

[gress]

The loss of self esteem resulting from how school treats kids is due to a fault with school, not with the kids.

[eruditely]

You're right, as long as we fix the schools and the parents. Of which the majority have little scientific background, will use vague inprecise heuristics such as you are not disciplined enough, as opposed to the much easier solution of providing drugs so that these kids not crash their vehicles.

Irresponsible apologism over and over while not demanding the same from the author. Anti-medication pop-trash.

[gress]

It sounds as though you are seriously promoting using drugs to control children's behavior to solve the problem of poor schools.

Downvotes? Am I misreading the parent?

[DerpDerpDerp]

No one is saying we shouldn't be giving drugs to some kids.

It's saying we're over diagnosing, and giving drugs to kids who don't need them.

Giving 1 in 20 boys amphetamines for no reason is not a good thing - it's a dangerous and bad thing.

[com2kid]

Thank you.

As I've stated before, either ADHD is real, or psychologists have found the world's best predictive test for auto accidents.

People with untreated ADHD have 3x the likelihood of being in an auto accident. 56% rate of substance abuse. Think about that for a moment.

56%. Holy shit.

These are the people who instead of getting help, were told that they are "lazy" and "needed to get up off their asses." Except that advice didn't work, what it does lead to is depression and dependency issues.

Oh then there is the fact that there are large structural brain differences.

I won't disagree that ADHD is over-diagnosed at times. I am horrified with how easily some people get an ADHD diagnosis, your general MD should not be making that call. There are multitudes of proper psychological tests for ADHD that should be chosen from, a 30 minute patient interview should not be the sole determining factor.

[gress]

Perhaps the tendency to call people "lazy" and "need to get up off your ass", is a personality disorder that should be treated with strong medication.

[legutierr]

> Oh then there is the fact that there are large structural brain differences.

Are these structural differences used in diagnosis?

[com2kid]

> Are these structural differences used in diagnosis?

Unfortunately testing costs money, I've rarely to never heard of it being used, but my sole experience is in helping people on ADHD support forums.

[dalke]

When you say it is a "fact that there are large structural brain differences", which differences did you mean? I may be focusing on the wrong thing. What I've found (brain size) doesn't have a clear enough difference to be used as part of diagnosis.

For example, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859218/ notes that head circumference and cross-sectional MRI measurements of brain size show that children diagnosed with autism have (on average) a larger brain size.

However, looking at the charts (for a head circumference chart, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869044/ ), while the data may be statistically significant, there's no clear separation between those diagnosed with autism and those with no indication of autism. Many of those with autism have a size smaller than the average of those without, and many of those without autism have a size larger than those with.

This means that head size or simple cross-sectional MRIs can't be used as a reliable diagnostic test.

Which structural differences where you meaning?

[com2kid]

Not the entire brain, just the portions that deal with self control! This is actually where the "Hyperactive" part of ADHD comes from, normally the parts of the brain that control motor skills and the parts that allow for self control grow in tandem, for children with ADHD, their motor skills outpace their self control. Their executive functioning eventually catches up, thus the myth of "children grow out of ADHD" came to be, since the "H" disappears, unfortunately the rest of the problems remain.

http://www.sciencedaily.com/releases/2012/07/120730094822.ht...

http://www.nami.org/Template.cfm?Section=ADHD&Template=/Cont...

[dalke]

Thank you for the pointers.

They appear to be about the same research program. They share the same author, Philip Shaw. From the first "We measured the thickness of the cortex across thousands of points in the brain in .. (466) children - half of whom had ADHD and half of whom did not" and from the second "They recruited 234 children with ADHD and 231 typically developing children ... they were able to map the trajectories of surface area development at over 80,000 points across the brain."

Even though they appear to be different efforts (the number of children involved are different and the years are different), there might still be some spurious correlations solely because the same people, with the same expectations and analysis technique, are involved.

Unfortunately, I am unable to read the primary literature. The first links to a paywalled journal article ($31.50), the second doesn't have a journal citation. I found http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342014/ by the same author, and published a couple of months after the article in the first link. Unfortunately, which it says there are distinguishable features, along with two reference comparisons, it doesn't give enough information to judge if those differences are truly diagnostic.

I did find http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440402/ which comments "The ADHD diagnosis rests only on these symptoms because no biological markers (e.g. genetic tests, brain imaging) have been validated [11]", but that reference [11] is from 2006, and older than the two links you gave.

A 2007 metaanalysis (so again, older than the two references you gave) at http://www.ncbi.nlm.nih.gov/pubmed/16950217 points out that at that time "Although there are many structural neuroimaging studies of attention-deficit/hyperactivity disorder (ADHD) in children, there are inconsistencies across studies and no consensus regarding which brain regions show the most robust area or volumetric reductions relative to control subjects."

To highlight the intent behind those last two previous paragraph, they are saying that there are many studies like the ones you pointed out, which show a correlation between some physical measurement and ADHD. Unfortunately, they don't seem to be consistent. Because of the well-known publication bias problem, it's likely that false positives are over-reported. It takes additional followup work to determine if those signals are really true, and if they are distinguishable enough to be used diagnostically.

This all tells me that there is no "large structural brain difference", and especially not one which has been validated as a diagnostic tool. There might be a small structural brain difference, but again, I find no evidence that identification of this difference is available as a diagnostic tool at all, even if the price were disregarded.

Again, I might be focusing on the wrong thing, but perhaps you may be misinformed? If most of your research is through the popular literature, then my earlier reference to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440402/ ("Why Most Biomedical Findings Echoed by Newspapers Turn Out to be False: The Case of Attention Deficit Hyperactivity Disorder") may be useful:

> Because newspapers preferentially echo initial ADHD findings appearing in prominent journals, they report on uncertain findings that are often refuted or attenuated by subsequent studies. If this media reporting bias generalizes to health sciences, it represents a major cause of distortion in health science communication.

[mattchew]

I'd like to read more about the structural brain differences, if you've got links.

[com2kid]

http://www.nami.org/Template.cfm?Section=ADHD&Template=/Cont...

http://www.kennedykrieger.org/overview/news/brain-imaging-st...

Really a search for "adhd brain development" yields plenty of results. :)

[mattchew]

Thanks for the reply.

I did note this:

Brain imaging is not ready for use as a diagnostic tool in ADHD, Shaw said."It is still too early to use neuroanatomical scans for diagnosis," he said. "We had to scan hundreds of children to identify subtle differences. They [the differences] are very real, but they are subtle. So the scan of any one child will not tell you a great deal about whether [he or she has] ADHD or not. Currently, the diagnosis of ADHD remains clinical."

http://www.psychiatrictimes.com/articles/brain-maturation-de...

A buddy of mine was telling me that you could diagnose ADHD with brain scans--this link seems to say the exact opposite.

[sheepmullet]

Nobody is saying that ADHD is not a real condition. The article is suggesting a lot of American boys are diagnosed with ADHD when they don't in fact have it. Imagine if 30% of people undergoing chemo for cancer treatment had never even had cancer.

I'd like to see what the rates are compared to other western countries. If its 5% in Canada and 20% in the US it suggests something is wrong

[jonah]

Why don't we try to get to the root causes of these "behavioral issues" instead of treating the symptoms.

[gizmo686]

Isn't that what ADHD medication tries to do. If the root cause is a chemical imbalance, then treating is as a behavioural problem is only treating the symptoms.

[gress]

There is no valid support for the chemical imbalance theory of mental illness. The reasoning is circular - "if chemicals reduce the symptoms, a chemical imbalance must have been the cause"

Edit: seriously downvotes? This isn't news:

http://en.wikipedia.org/wiki/Chemical_imbalance

[dalke]

Or read http://www.madinamerica.com/2014/03/psychiatry-admits-wrong-... :

> BL: In Anatomy of an Epidemic, you also discussed the pseudoscience behind the “chemical imbalance” theories of mental illness—theories that made it easy to sell psychiatric drugs. In the last few years, I’ve noticed establishment psychiatry figures doing some major backpedaling on these chemical imbalance theories. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” ...

> RW: In a sense, Ronald Pies is right. Those psychiatrists who were “well informed” about investigations into the chemical imbalance theory of mental disorders knew it hadn’t really panned out, with such findings dating back to the late 1970s and early 1980s. But why then did we as a society come to believe that mental disorders were due to chemical imbalances, which were then fixed by the drugs? ...

RW then goes on to list a couple of likely reasons.

[jonah]

I'll bite. Where does the imbalance come from?

It doesn't come from not taking your medications.