Over-diagnosis of ADHD?

Xelebes said:

Yikes, the science in that looks dodgy. Some of the conclusions drawn in some of the presentations there are absolutely nonsensical.

Especially that Professor Bentall article in the articles section.

Using a graph from 1939 and using the same conclusion drawn there, yeah no. The study factors not the migrational patterns of humans: people who perform poorly (mentally ill) end up in lower-class accomodations. This often means that they are deprived of land (do not own land and thus are often pushed off the farms) and end up in the city to muster a living.

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Sorry, I didn't look at the site very closely. The ones we studied were from Wikipedia describing the project and it's success. I was trying to grab an up to date link but it serves me right for not looking it over before posting it.

AncientEagle said:

This merits all kinds of emphasis. The son of a personal friend, some years back, was severely schizophrenic. At some point, he felt good enough that he was sure he didn't need to stay on his meds. He hanged himself in the back yard.

A less lethal but still quite serious case involved my son, who has battled severe clinical depression since his teen-age years. Years ago, he had been on an even keel for a long spell and felt so "normal" that he insisted he no longer needed to take his anti-depressant. Not only did he become extremely physically ill, but the depression returned with a vengeance and took forever to get damped down again.

And for what it's worth, "talk therapy" has been so unsuccessful with him that he won't consider ever trying it again. Meds have burned out on occasion, and he has had months-long battles just trying to come out of the black fog while trying something else, but his meds are working now. And they, in one form or another, are the only thing that has ever worked.

Sorry if this is a tad off the subject.

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It's not as off the subject as you might think. As per the original ADHD overdiagnosis, these children are being put on powerful mind altering drugs. If those drugs are suddenly stop the feedback from it can be catastrophic. Brains become chemically dependant on that stuff and if a person does want to go off the meds, they should take their time in a very long slow taper under careful supervision.

And yeah, unfortunately therapy does not work for everyone. My lament is that powerful mind altering substances are the first and far too often go to for everyone with every sort of "mental illness". Not that medication is inherantly evil or those who find relief in it are weak or anything close to that. To add to that, the current diagnositic accuracy rates are just as bad as they were thirty years ago. Current figures peg is as 1 in 3. That is if you send the same patient with the same symptoms to three different psychiatrists they'll come up with three different diagnosises.

I myself battled this with medical doctors for years who ended up putting me on a pretty powerful anti-psychotic. Turned out I had celiacs disease and all I had to do was alter my diet to be fine.

I made the mistake of going off them over night from 500 mg to nothing. I couldn't believe how many symptoms I had as a result of the medication. It had nothing to do with me, it had everything to do with the medication and how my mind had altered it's own natural chemistry to fit the medication.

A lot of this stuff reminds me of a couple decades ago when I had the chronic, progressive and incurable disease of alcoholism.

ADD/ADHD tends to be underdiagnosed in women and girls, since the descriptive traits of the disorder are masculinized and behavior problems in girls are often attributed to character deficits rather than medical issues.

I'm on the ADD/ADHD spectrum. By the time I was 8, I had:

(1) Accidentally stolen a pack of balloons from a grocery store (pure daydreaming inattention - just wandered outside with 'em while preoccupied with whatever drama was playing out in my head, and subsequently started screaming in the parking lot).
(2) Accidentally fallen out of a magnolia tree, wandered in front of several youngsters on a swingset and had my head injured, etc. etc.
(3) Accidentally knocked out my little sister's front teeth (beanbag chair + stairs = bad combo for toddlers; who woulda thunk it?).
(4) Accidentally busted my little sister's forehead open...
(5) Accidentally busted my little sister's chin...

(Notice a theme here? And I love my little sister more than breath itself.)

By the time I was 15, I had:

(6) Accidentally sprayed myself with Mace.
(7) Accidentally ripped off my own corneas.
(8) Forgotten many test dates in school, as well as homework, and occasionally my own shoes.
(9) Forgotten to give water to my pet for a few days until I discovered he was dying and it was too late.
(10) Made brownies with salt instead of sugar, multiple times.

By the time I was 23, I had:

(11) Wandered into a park in Europe by myself on an early Saturday morning (did you know that this is an excellent way to be sexually assaulted by drunk hobos? I did not).
(12) Gotten into a cab without its light on... not going to elaborate on this...

Need I go on?

Teinz said:

I wonder where ADHD was 20 years ago.

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It's always been around. ADHD folks tend to gravitate towards the trades, the arts (especially comedy), the military, athletics, education, entrepreneurship, medicine and other caregiving professions, law enforcement, veterinary care/animal rehabilitation, invention and IT work, and the clergy.

Or in the worst cases (more often lately, as mere human existence becomes more and more criminalized), they end up on the wrong side of the penal system.

Gilroy Cullen said:

The article did suggest that the South East was the worst area.

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This is likely because smoking during pregnancy is relatively common in the southeast.

veinglory said:

any more than it would be for MS and other disorders or those where markers can be accessed only after death (dementias etc)

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Could you expand on this, in terms of genetic testing?
Are there still so many diseases/disorders, particularly when looking at neuro/neuromuscular disorders, that can't be determined through whole exome sequencing?

veinglory said:

I would predict that such bio markers will not be found for most mental disorders within the next century. So that is not really a here-and-now solution, any more than it would be for MS and other disorders or those where markers can be accessed only after death (dementias etc)

Diseases are real if they are experienced. I think how they are categorized and how fraud is handled is a secondary bureaucratic issue.

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I was under the impression that disease in medicine had a specific definition, but perhaps the mental health field is separate from medicine.

ap123 said:

Could you expand on this, in terms of genetic testing?
Are there still so many diseases/disorders, particularly when looking at neuro/neuromuscular disorders, that can't be determined through whole exome sequencing?

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It should be obvious that some diseases aren't caused by genetic defects. Lung cancer is mostly caused by smoking. There may be cases where it is genetically caused, but with as the great majority of cases are caused by smoking, any possible genetic cause isn't well studied.

And there are many "behavioral health" conditions that it's hard for me to imagine having genetics as part of the cause, such as compulsive gambling and sex addiction.

benbradley said:

I was under the impression that disease in medicine had a specific definition, but perhaps the mental health field is separate from medicine.

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Diseases and disorders have definitions that are, in a great many cases, a list of symptoms as experienced by the patient.

Even in cases with a specific organic cause (gene, virus etc) the individual is usually diagnosed exclusively via symptoms, most of which are subjective. (Does your doctor extract a flu virus and look at it before agreeing to diagnose and treat the flu? I doubt it.)

In most cases we have no idea whatsoever what causes a specific person to have a specific cancer. We have vague epidemiological correlations. That is all.

We have only the vaguest idea of what debilitating chronic conditions like Parkinson's and Altzhiemer's really are, diagnose them from symptoms, and often don't even confirm this diagnosis even post mortem.

That is why I would say a great deal of disease is purely a matter of lived experience. But some people get to know what the basic physical cause is (to some extent) and other people don't. I see no reason to consider the status of the latter group as "lesser" because their conditions are more poorly understood.

Many psychological conditions are the result of gene-environment interaction, rather than one or the other.