That sort of jibes with my corrupted memory.
>
>I never meant to imply that ADD/ADHD was fictional or mythical - simply
>that it very often diagnosed in non-ADD/ADHD kids.
>
>The diagnosis process isn't very well defined and often subjective and
>medication is often issued to mold behavior to adult desires rather than
>correct truly disordered behavior. In effect the issue has become a
>social one rather than a pathological one.
>
>Medicine is just like any other field - it often features "fads", and
>ADD/ADHD is a current one. Child development workers, for a long time,
>believed Bruno Bettelheim's [sic, cuz I'm lazy] theory than autism was
>caused by neglectful "icebox mothers". Skinner's pure behavioral
>modification theories were also very popular for a long time. Even
>purely physical diagnoses go through phases - for a long time having
>your tonsils out was a very common procedure; not any more.
ADHD is not related to Asperger's Syndrome or Autism. With ADHD
medication helps. Recent research has generally shown that medication
is very effective, as is behavioral/cognitive/educational approaches
to therapy. What is not surprising to me is that the combination of
"Psychological" and medical therapies tend to work the best. Moreover
the two potentiate each other, and the combination is far more
effective than either alone. But that has been the most common
finding in psychiatric therapeutic research in general.
>But there are more fads in child development that in nearly any other
>field. Now ADD/ADHD isn't a "fad" i n the sense of it being ridiculous,
>but rather in the sense that diagnosis of the disorder have sky
>rocketed. This is often due to drug companies (who push new drugs to
>physicians who in turn tend to find those problems more) and, I think, a
>desire for a quick fix.
I'm not too sure its as much of a fad as the reporting of it has
changed over the years. I'm talking about it at the professional
psychology level, where empirically based and standardized
instruments and observational checklists based on the DSM-IV/V are
used to make a differential diagnosis. An actual clinical
psychological diagnosis of ADHD is very strict and has to follow a
set of parameters, the failure to meet any two means that the
diagnostic criteria are not met. However most so-called ADHD
diagnoses are not made by clinical or educational psychologists,
rather they are made by poorly trained (in terms of psychological or
psychiatric diagnosis) pediatricians or general practitioners.
Moreover seeing a kid for about 15 minutes and then moving on to the
next one to meet HMO standards does not serve anyone very well,
except large insurance and drug companies. Moreover a treatment plan
needs to be set up following the diagnosis that would encompass the
educational, social and psychological aspects of the child. This
cannot be done in the 15 minutes allotted to the patient in most
pediatric and GP clinics and group practices. All too often these
treatment plans only mean that the kid is given ritalin and similar
drugs, and that's it. No educational plans, no family therapy, no
training in how to compensate for these deficits are given.
>There's also a lot of "clumping" going on. For example a child who is
>susceptible to fluorescent lights may be diagnosed with ADD and placed
>on ADD medication, when in fact a behavioral modification (namely
>staying away from those lights) is the real answer. Many other problems
>are being diagnosed as ADD/ADHD and being treated unnecessarily with
>medication.
>
>Again that doesn't mean it doesn't exist - just that it's not nearly as
>common as some believe.
Again the paucity of real diagnostics is the problem. Parents become
convinced that little Johnny has ADHD, when he may just be depressed.
In the GP's or pediatrician's office, the 15 minutes of questioning
(if that) results in a prescription, nothing more. In a more proper
setting where an assessment team does the assessment, the behavior
problem can be more accurately determined. Of course though that
means that the cash goes out of the pediatrician's office, and that
the insurance company is far less likely to cover such a
comprehensive diagnostic system.
As for the percentage within the population, I've seen studies that
have estimated that ADHD is in anywhere from 5 to 20% of all school
aged kids. Myself I am inclined to go with the lower number, as the
couple of studies that provided the higher number had a far more
liberal definition of ADHD. Unfortunately a lot of acting out
behaviors can mask as ADHD symptoms, and as such is misdiagnosed -
i.e., bi-polar disorder, depression, anxiety, reactions to family
stresses or divorce for example.
regards,
larry
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