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by com2kid
4459 days ago
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> The limited search I did of the primary literature does not seem to give the same conclusion as what you have stated. While I don't know the literature, nor the field, I will be so bold as to suggest that things you believe to be true about ADHD are actually not so well understood as you believe them to be. Again I'd encourage you to watch the linked to video. ADHD has many subtypes, co-morbidity differs based on subtype. There are some important genetic links as well. |
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1) there are "large structural brain differences" between those with and without ADHD, and
2) there is a 'tragically' high co-morbidity between bipolar disorder and ADHD
The literature, as best as I could determine, says that there are no large structural differences, and there isn't a tragically high co-morbidity. I pointed you to relevant research articles which say that. It seems that you are trying to change the topic. My tentative hypothesis is that your knowledge of ADHD helps you cope with the disease, and you don't want to evaluate the possibility that some of your knowledge may be incorrect.
Rather than point to research which confirms you point (2), you now say that there are "many subtypes, co-morbidity differs based on subtype." That's a perfectly reasonable argument, but it's a different argument than your previous one. You previously wrote "ADHD's co-morbidity with bi-polar disorder is tragically high" not "co-morbitity between some subtypes of ADHD and bi-polar disorder is tragically high."
That's okay - this is HN, not peer-reviewed literature and I don't expect you do put in all of the details when you first write something. My question is only, how do you know that what you wrote is true?
You pointed me to a video. I stopped after 23 minutes into it because it was low-information content and I didn't like the speaker's style. There are no links to the primary research, no qualifiers or evidence as to the certainty of the speaker's statements, and some terms used (like "psychopathy" at 18:03) have no basis in the DSM and are only used for general public lectures. This sounded very much like someone who has a specific model of ADHD and is looking for evidence which confirms that model, rather than for evidence which break the model.
As an example, 20:45 ("just a milder variant of the combined type") combined with the further ("it's simply a group where parents confuse oppositional behavior with ADHD"). This is odd because ADHD is not diagnosed by the parents. In addition, in his paper at http://www.ncbi.nlm.nih.gov/pubmed/22179974 he uses parental input in his own research uses parental input to design a 3-part model. How does he determine when the parents are "confused" and when they are not?
I had to stop at 23:24 because the presentation was too information-poor to be interesting. I couldn't tell which were his views and which were conclusions drawn from research, and more importantly, I couldn't tell if he understood the difficulties in that research.
For example, he says sluggish cognitive tempo is an ADHD subtype (actually, in http://www.ncbi.nlm.nih.gov/pubmed/24394633 he "conjecture[s] that SCT is probably distinct from ADHD rather than being an ADHD subtype, although there is notable overlap with the ADHD predominantly inattentive and combined presentations." That detail isn't relevant for the rest of this post, but I will point out that it's equivalent to saying that ADHD is likely overdiagnosed.)
Further, at 17:17 he says that identification of co-morbitity is a simple linear test.
This goes back to your point (2) and your modification that there are several subtypes.
Did you read the http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028268/ link I pointed out earlier? It lists 5 different ways to get false co-morbitity. Since you emphasis that "co-morbidity differs based on subtype", I refer specifically to its point (3).
> (3) Over-Splitting: Artificial Subdivision of Syndromes
> There is a long and fruitful debate between “lumpers” who favor diagnostic parsimony versus “splitters” who prefer carefully nuanced clinical description. Over-splitting would create a falsely inflated rate of comorbidity by treating multiple components of the same larger diagnostic entity as separate conditions that frequently co-occur. High rates of comorbidity thus invite questions about whether a nosological system is over-splitting.
In other words, if you add more subtypes then you would expect to see higher co-morbidity even if it were due to over-splitting, and not based on actual subtype differences.
Thus, increased co-morbitity alone can't be used to tell if a subtype exists.
But neither you nor the presenter have provided the evidence that that increased co-morbitity is anything other than a false signal. (I would also like to see evidence of the increased co-morbitity vs. subtype, but am willing to accept your word on it, because that's what I expect.)
Actually, the speaker's elision of the difficult details reminds me of this quote from http://www.madinamerica.com/2014/03/psychiatry-admits-wrong-... :
> By doing so, psychiatry allowed a “little white lie” to take hold in the public mind, which helped sell drugs and of course made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don’t expect to be misled in such a basic way.
Is the speaker misleading me by telling a "little white lie"? I looked at the presenter's research literature. Most deals with adult ADHD, sluggish cognitive tempo, and executive function. Based on the abstracts, I see he prefers "theoretically driven .. approaches" (http://www.ncbi.nlm.nih.gov/pubmed/18295154 ), which fits my idea that prefers to fits things to a model rather than test the validity of the model first. (Models are useful, because they allow you to make predictions. Models are terrible, because they don't fit reality. This is an old debate.)
What I don't see in his research is anything about how there are "large structural brain differences" nor how there is a 'tragically' high co-morbidity between bipolar disorder and ADHD, which are the two statements you said are true about ADHD.
Again I ask that you tell me how you came to your two conclusions, since the literature seems to disagree with you and nothing you've referenced seems to actually address those points.