When you were a kid, didn’t you run about all the time for no particular cause? Didn’t you continuously turn your concentration from one thing to the other? Didn’t you have a tough time sitting motionless? Didn’t you have a tough time concentrating on one thing, for long span of time? You were a kid and you behaved the manner in which nearly all children do. You did not reflect about things, you simply did them since at that age, there was no thinking procedure. Nearly all children get through this stage in their early life, but science has gone ahead and told us that perhaps this action is not so normal.
Attention Deficit Disorder, how do we describe it? You would believe with all the great minds in the world that somebody would have come up with a description that suits. But that is not the case – it appears that ADD is an arbitrary definition and not essentially an illness.
There is still puzzlement over who does and does not have ADD. A few associates of the mental health association had a demand to categorize any person with ADD, as having a brain deficiency. Apparently this was as a result of the fact that the first group of ADD patients that were studied had been ill with encephalitis, which is an inflammation of the brain. But this criterion no longer is no longer valid, for the reason that over the years, people with no brain deficiencies, have been added to the roll call of ADD.
At this time, there are two most important kinds of ADD. ADD with hyperactivity and ADD without hyperactivity. Indications of ADD plus hyperactivity are described as: can’t keep on seated, restless, climbs or runs a lot, talks much, can’t play peacefully and also having a tough time standing in line or waiting for their turn. A few indications of ADD without hyperactivity are, disordered, having a tough time concentrating on tasks, with no trouble getting diverted and does not appear to pay attention.
Therefore, who has ADD? The numbers by and large given are 3 to 5 percent of the people. But no one knows. Since ADD is so arbitrary, it is apparent that several who are listed as ADD, may not even fit in there.
There is still an important debate going on as to the validness of ADD. Is it genuine? A number of people say that ADD is not an illness, but a compilation of mannerisms and indications, that may possibly be generated by any number of troubles. And when you include the reality that the specialists in the field, can’t even make a decision on what precisely ADD is and who precisely has it, then this only gives more credibility to those that gave a suspicion over the presence of ADD. Of course there are lots of people who consider that ADD is genuine and not just some stage a person is going through. They consider that people ought to be taken care of for their symptoms and not be anticipated to just get out of them.
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The writer’s failure to read, let alone understand the DSM4, condemns this stream-of-conciousness to where it belongs, the trash can. Within professionally competent circles, there is little doubt that there is a phenomenon which we label ADHD. If there is doubt, it revolves around just what constitutes the cut-off point. DSM4 is clear in that it indicates that abnormality of behaviour is the criterion for inclusion. What constitutes abnormality differs from observer to observer and setting to setting. However these differences are minor in relation to the acceptance of the basic concept.
Where problems arise is that DSM4 discusses a dimensional problem (0 to 100%) in categorical terms (you have it or you don’t) this leads to differences in interpretation.
A second area of debate arises in that DSM4 discusses ADHD only in terms of behaviour without addressing the underlying causality. Thus the oft cited complaint that there is no objective test for ADHD. Some such as Daniel Amen would point to imaging studies which clearly differentiate disturbed brain function in ADDers from normal brain function in neurotypicals. This is a pragmatic approach with clinical usefulness but it still avoids the unambiguous objective measurement.
Others will point to genetic studies (Hay and Levy etc.) which show a strong genetic influence. Still this is subjective as the incidence and diagnostic rate of ADHD would appear to be increasing faster than genetics would allow. This might suggest an environmental impact via epigenetic mechanisms (similar to that which Jill James work on autism would suggest).
From the genetics studies, a range of candidate genes have been identified which clearly can influence the course of ADHD and the outcomes. However, the problem is broad in that a great number of genes are involved and that the impact of SNPs (Single Nucleotide Polymorphisms) has yet to be robustly evaluated.
So it all comes back to subjective assessment. Where subjective assessment has failed is in the lack of studies of adults with ADHD where correlations are made with childhood histories and phenomena against adult status.
Ask a group of adults with ADHD and you will get a remarkably consistent set of stories regarding childhood, regarding interpersonal relationships and regarding work. It is not coincidental.
Another problem not addressed by DSM4 is the sex ratio. At the earliest age of diagnosis, boys outnumber girls at least 5 to 1. By adulthood, the ratio is far closer to 1 to 1. What have we failed to define in young girls that is a marker for serious problems in adult women?
Another real issue is that of comorbid disorders, particularly depression and anxiety, which are so rooted in the development of ADHD that they would seem inseparable. Conventional diagnostic hierarchy would deny the links and see the anxiety and depression as separate treatable disorders yet the astute clinician will see the triumvirate, assess correctly that ADHD is the root cause, treat the ADHD and watch the anxiety and depression suddenly become manageable.
Another comorbidity often overlooked is obsessive and compulsive behaviour. These are often survival skills for ADDers with poor working memory issues yet are rarely seen as survival traits but treated separately as disorders in their own right.
When it is all boiled down, when Fred Baughman is seen for what he is (“All progress in psychiatry ceased in 1948″), when the apologists for a religious enterprise are seen as having unstated agendas and the relationship between big pharma and illness are understood, ADHD stands out as a discrete entity, robustly and unambiguously recognised at the core even if a little ragged at the edges. Such is the progress of science.
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.” Max Planck 1948
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