Does
ADD Really Exist?
Why
is this a problem?
Sample
Response to a Person with a General Lack of Knowledge of ADD
Sample Response to a Person Who's Strongly Denying ADD Exists
Clinical Evidence of The Existence of ADD as a Real Condition
Why
is this a problem?
Occasionally I read about people who claim that ADHD doesn't
exist. As if you cut down on sugar intake, turn off TV and
computer games, and spin around 3 times and click your heels
it will magically disappear.
Well,
that is not true. For the people who have to deal with the
challenges of ADD, especially adults, who often have few resources
available to them, this is like kicking someone when they're
down. Many people with ADD don't seek diagnosis or treatment
for themselves or their children because of the stigma created
by some judgemental ignorant people.
Would
you tell someone who's a diabetic that he shouldn't take insulin,
it's not good for them, diabetes is a phoney condition thought
up by the drug companies and all they have to do is stay away
from the chocolate bars and have happy thoughts?
Why
is it that people who would not assume they're knowledgeable
enough to make pronouncements of the validity of physical
medical conditions assume that they are knowledgeable enough
to make sweeping pronouncements of the validity of mental
medical conditions?
Why do they then decide (usually without doing any real research
on the subject) that they know enough about what are acceptable
and unacceptable treatments ( i.e., Ritalin as a tool of the
devil theory) and condemn someone for using what they deem
are unacceptable treatments? As if the brain is easier to
understand than the body.
While
ADD is sometimes underdiagnosed, overdiagnosed and misdiagnosed,
it is a real condition with often severe negative consequences
for the person who has it.
Once they learn about the condition and begin to deal with
it, by medication, coaching, therapy, support groups or other
methods. Then they can start focusing on and developing the
advantages of having ADD.
Unfortunately, too many people with ADD don't even get diagnosed
because of the misinformation and stigma out there by the
ignorant (occasionally vocally ignorant). You can't deal with
what you don't know you have.
So
I've put together a few links to articles that give hard,
clinical evidence of the existence of ADD as a real condition.
If you have ADD, how you decide to treat it should be your
choice not something that is dictated by others. After all
you're the one who has to deal with the consequences of your
choices (or of simply continually researching the condition
with little action).
Sample
Response to a Person with a General Lack of Knowledge of ADD
If someone simply has a lack of knowledge about ADD, or believes
the myths out there, you can give them this blood pressure
analogy to explain it.
"
We all have blood pressure. If it's in x range it's normal,
if it's in y range it's a cause for concern, and if it's
in z range you have a medical condition called hypertension
and have to be treated for it."
You
could use a similar example with blood sugar levels. I.e.,
occasionally low blood sugar, hypoglycemia and diabetes. You
could also use the example of clinical depression. Some people
have some of the symptoms of depression on occasion i.e.,
they may feel sad and depressed for a single day but that
does not make them clinically depressed. You need to have
a certain number of symptoms over a certain period of time
and a certain degree of severity.
Most
people have some of the symptoms of ADD on occasion, what
makes it ADD is:
- How
many of the symptoms you have
- How
severe the symptoms are
-
The degree that they negatively effect one or more areas
of your life
- How
long they have been a problem in your life.
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Sample
Response to a Person Who's Strongly Denying ADD Exists
If
that doesn't work and you're dealing with someone who is strongly
denying that ADD exists and claiming that ADD is a not real
condition, thereby stigmatizing those with ADD and preventing
other people who may have undiagnosed ADD from seeking treatment,
you might consider asking them this question,
"What
do you know about ADD that the following institutions don't?
American Medical Association (AMA)
Canadian Medical Association
Canadian Psychological Association
Canadian Psychiatric Association
Surgeon General of the United States
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
American Academy of Pediatrics (AAP)
American Academy of Child and Adolescent Psychiatry (AACAP)
(See the bottom of this page for more details
Real Science Defines AD/HD as Real Disorder).
They all say ADD exists and is a real condition.
What research have you done that show's that all of the
organizations above are wrong?"
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Clinical
Evidence of the Existence of ADD as a Real Condition.
Warning to readers! Scientific jargon ahead.
International
Consensus Statement on ADHD PDF
From Attitude Magazine. 75 international scientists were deeply
concerned about the periodic inaccurate portrayal of ADHD
in media reports. So they "created this consensus statement
on ADHD as a reference on the status of the scientific findings
concerning this disorder, its validity, and its adverse impact
on the lives of those diagnosed with the disorder as of this
writing (January 2002)"
Here's one particular quote I like
"To publish stories that ADHD is a fictitious
disorder or merely a conflict between today's Huckleberry
Finns and their caregivers is tantamount to declaring the
earth flat, the laws of gravity debatable, and the periodic
table in chemistry a fraud."
Two
anterior regions of the corpus callosum were significantly
smaller
in ADHD boys. MRI scans assessed the frontal circuitry
in 18 ADHD boys in comparison to 18 matched controls. They
found that two anterior regions of the corpus callosum (the
rostrum and the rostral body) were significantly smaller and
concluded that this was evidence for frontal lobe dysfunction
and abnormal development. The callosal fibres in the rostral
body relate to the premotor cortex, which is critical for
“the suppression of relatively
automatic responses to certain sensory stimuli”. This
is consistent with a defect in the person’s ability
to inhibit responses, which is considered by Barkley to be
the fundamental deficit in ADHD.
Brain
Imaging Data of ADHD
Psychiatric Times August 2004 Vol. XXI Issue 9. Amir Raz,
Ph.D. Assistant professor of clinical neuroscience in the
department of psychiatry, at the Columbia University College
of Physicians and Surgeons. Documents how advances in the
functional imaging of the living brain are shedding new light
on our understanding of the pathogenesis, pathophysiology
and treatment of ADHD.
Brain
Scans Reveal Physiology of ADHD
Psychiatric News 2004. New high-resolution, three-dimensional
maps of the brains of children with attention-deficithyperactivity
disorder indicate significant and specific anatomical differences
within areas of the brain thought to control attentional and
inhibitory control systems, compared with brain scans of children
without ADHD.
The images are thought to be the most advanced to date to
reveal the anatomical basis of the disorder. Includes two
3d scan photos.
Cerebral
glucose metabolism in adults with ADHD
The New England Journal of Medicine. Researchers
measured adults with ADHD with a PET scan. None of the adults
had ever been treated with stimulant medication. RESULTS.
Global cerebral glucose metabolism was 8.1 percent lower in
the adults with hyperactivity than in the normal controls.
The largest reductions were in the premotor cortex and the
superior prefrontal cortex--areas earlier shown to be involved
in the control of attention and motor activity. The largest
reductions were in the premotor cortex and the superior prefrontal
cortex--areas earlier shown to be involved in the control
of attention and motor activity.
The
dopamine theory of ADHD
Australian and New Zealand Journal of Psychiatry. The
dopamine theory of ADHD is supported by neuroimaging, genetic
and stimulant medication studies, which confirm an inhibitory
dopaminergic effect at striatal/prefrontal level. Anterior
and posterior attention systems are involved in inhibition,
working memory and orientation. Attention deficit hyperactivity
disorder symptoms and subtypes are likely to reflect deficits
in both inhibition and working memory, and may be heterogenous.
PET, SPECT Studies Find More Evidence of Dopamine's Role in ADHD
From Medscape. Free registration required. Studies using positron emission tomography (PET) and other approaches suggest new details about the underlying biology of ADHD. Released here at the 50th annual meeting of the Society of Nuclear Medicine. 3 different studies mentioned.
Caudate nucleus volume asymmetry predicts ADHD symptomatology in children.
Journal of Child Neurology. 2002 Dec;17(12):877-84
Schrimsher GW, Billingsley RL, Jackson EF, Moore BD 3rd. Department of Psychology, University of Houston, Houston, TX, USA.
A greater degree of right to left caudate volume asymmetry predicted subclinical inattentive behaviors in a sample of nonreferred children. This finding is congruent with neuroanatomic models of attention emphasizing lateralized alteration in prefrontal/striatal systems. The results support the view that clinical ADHD is the extreme of a behavioral continuum that extends into the normal population.
ADHD is characterized by a delay in cortical maturation
Proceedings of The National Academy of Sciences of the USA
We found maturation to progress in a similar manner regionally in both children with and without ADHD, with primary sensory areas attaining peak cortical thickness before polymodal, high-order association areas. However, there was a marked delay in ADHD in attaining peak thickness throughout most of the cerebrum: the median age by which 50% of the cortical points attained peak thickness for this group was 10.5 years (SE 0.01), which was significantly later than the median age of 7.5 years (SE 0.02) for typically developing controls (log rank test χ(1)2 = 5,609, P < 1.0 × 10−20). The delay was most prominent in prefrontal regions important for control of cognitive processes including attention and motor planning. Neuroanatomic documentation of a delay in regional cortical maturation in ADHD has not been previously reported.
Supporting info and movies here
Cortical Thinning of the Attention and Executive Function Networks in Adults with ADHD
Cerebral Cortex 2007 17(6):1364-1375. ADHD has been associated with structural alterations in brain networks influencing cognitive and motor behaviors. Volumetric studies in children identify abnormalities in cortical, striatal, callosal, and cerebellar regions.
We carried out a structural magnetic resonance imaging study of cortical thickness in the same sample of adults with ADHD... Compared with healthy adults, adults with ADHD showed selective thinning of cerebral cortex in the networks that subserve attention and EF. In the present study, we found significant cortical thinning in ADHD in a distinct cortical network supporting attention especially in the right hemisphere involving the inferior parietal lobule, the dorsolateral prefrontal, and the anterior cingulate cortices. This is the first documentation that ADHD in adults is associated with thinner cortex in the cortical networks that modulate attention and EF.
Attention and Executive Systems Abnormalities in Adults with Childhood ADHD: A DT-MRI Study of Connections
Cerebral Cortex 2008 18(5):1210-1220; doi:10.1093/cercor/bhm156. In this study of adults with childhood ADHD, we hypothesized that fiber pathways subserving attention and executive functions (EFs) would be altered. To this end, the cingulum bundle (CB) and superior longitudinal fascicle II (SLF II) were investigated in vivo in 12 adults with childhood ADHD and 17 demographically comparable unaffected controls using DT-MRI. Relative to controls, the fractional anisotropy (FA) values were significantly smaller in both regions of interest in the right hemisphere, in contrast to a control region (the fornix), indicating an alteration of anatomical connections within the attention and EF cerebral systems in adults with childhood ADHD. The demonstration of FA abnormalities in the CB and SLF II in adults with childhood ADHD provides further support for persistent structural abnormalities into adulthood.
Volumetric
MRI analysis comparing subjects having ADHD
with normal controls. Despite similar hemispheric volumes,
ADHD subjects had smaller volumes of (1) left total caudate
and caudate head (p <0.04), with reversed asymmetry (p
< 0.03); (2) right anterior-superior (frontal) region en
bloc (p < 0.03) arid white matter (p < 0.01); (3) bilateral
anterior-inferior region en bloc (p <0.04); and (4) bilateral
retrocallosal (parietal-occipital) region white matter (p
< 0.03). Possible structural correlates of ADHD response
to stimulants were noted in an exploratory analysis, with
the smallest and symmetric caudate, and smallest left anterior-superior
cortex volumes found in the responders, but reversed caudate
asymmetry and the smallest retrocallosal white matter volumes
noted in the nonresponders.
ADHD: More Prevalent Than We Thought?
LARISSA HIRSCH, MD Instructor of pediatrics at New York Presbyterian Hospital, medical editor for KidsHealth.org and CHARLES A. POHL, MD, professor of pediatrics and associate dean of student affairs and career counseling at Jefferson Medical College in Philadelphia
There are frequently stories in the news and talk among the public of the over-diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in today's hypervigilant society. However, a study recently published in Archives of Pediatrics and Adolescent Medicine may serve to debunk this common belief...Interestingly, only 47.9% of the caregivers of children who met the DSM-IV criteria in the past year reported that the disorder had been diagnosed in their child...Children from the lowest income group received less consistent treatment than those in higher income groups.
The Froehlich study indicates that we are under-diagnosing ADHD. We need to be on the lookout for children with this disorder, make an accurate diagnosis, and do our best to follow affected children closely.
7 Myths about ADHD
From Schwab Learning.
12 Myths about ADHD
From ADDConsults.
Real
Science Defines AD/HD as Real Disorder
From CHADD. Some of the most prestigious scientific-based
organizations in the world conclude that AD/HD is a real disorder
with potentially devastating consequences when not properly
identified, diagnosed, and treated. Excerpts from the following
organizations.
American
Medical Association (AMA), Surgeon General of the United States,
National Institutes of Health (NIH), Centers for Disease Control
and Prevention (CDC), American Academy of Pediatrics (AAP),
American Academy of Child and Adolescent Psychiatry (AACAP)
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