Paediatrician: "ADHD does a disservice to children as a diagnosis" (News article)

The Black Oil

Picked this up from NPR

The interviewee is Dimitri Christakis, a professor of pediatrics.

Diagnoses of attention deficit hyperactivity disorder are up around 30 percent compared with 20 years ago. These days, if a 2-year-old won't sit still for circle time in preschool, she's liable to be referred for evaluation, which can put her on track for early intervention and potentially a lifetime of medication.

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Researchers are currently debating the nature of ADHD. They have found some genetic markers for it, but the recent rise in diagnoses is too swift to be explained by changes in our genes. Neuroscientists, too, are finding brain wiring patterns characteristic of the disorder.

But the current process of diagnosis amounts to giving a questionnaire to parents and doctors. If they identify six out of nine specific behaviors, then the child officially has ADHD.

"If you fall on this side of the line, we label and medicate you," says Christakis. "But on the other side of the line, we do nothing."

This process is, necessarily, subjective. But there's an awful lot of infrastructure and, frankly, money behind it, especially in our education system. A clinical diagnosis of "chronic or acute" attentional difficulties gives public school students a legal right to special accommodations under the Individuals with Disabilities Education Act. But a child who falls just short of that diagnosis is left without any right to extra support.

Christakis says that, instead, we should be thinking more about a spectrum of "attentional capacity" that varies from individual to individual and situation to situation.

I'll admit that I don't know a lot about ADHD in terms of the diagnostic process. Having seen it discussed in a 'internet news article comment section' type way, there tends to be a 'over-diagnosed and over-medicated' perception attached to it. On a more grounded level, I think someone who contributes here - Valmont(?) has in the past taken issue with behavioural observations as the foundation of diagnoses, in general.

Christakis says that, instead, we should be thinking more about a spectrum of "attentional capacity" that varies from individual to individual and situation to situation.

That sounds sensible.

The NPR article arose due to an editorial by Prof. Christakis.

In the case of ADHD, a clinician performs a series of assessments by having parents and teachers report their observations of the child on a standardized form. In one of the most widely used and well-validated measures of ADHD, a child needs to demonstrate 6 of 9 specific behaviors to be diagnosed as having ADHD.4 Each of those behaviors are based on a parent or teacher reporting that a child does something “often” or “very often” such as “have difficulty organizing tasks and activities” or “loses temper.” Those answers are used to determine whether the child falls in the pathological range. If they do, we prescribe medications or cognitive behavioral therapy. We give special accommodations at school and try to structure their environment to be less distracting. But if the child scores just below the cutoff, we reassure the parent that their child does not have ADHD and offer them essentially nothing. Paradoxically, many children would be better off if they scored 1 to 2 points worse on the assessment, thereby availing themselves of things from which they too would benefit in both the short and long term. Distinguishing between children with “pathological deficits” in attention and those without them belies the fact that all children would benefit from better executive function. In fact, much as we have moved from a diagnosis of “autism” to “autism spectrum disorder,” we should move from a diagnosis of ADHD to one of attention-deficit/hyperactivity spectrum disorder. Accordingly, the shift should be from treating attentional capacity as a clinical disease to recognizing that we need to do all we can to help children maximize their ability to focus.

Any here who is more informed care to comment?

dar100

I also don't know much about ADHD. However, the increase in diagnoses in the last number of years, is very alarming.

Again, we see the lack of flexibility when describing experiences as disorders, instead of looking at them as spectrum phenomenons. Additionally there are serious concerns regarding the behavioural observations utilized to diagnose ADHD.

How are so may young individuals diagnosed with this "disorder"? It would seem to me, that there is a direct correlation between how much this is promoted by medical individuals, and advertising by big pharma in America, (anecdotal I know).

The Black Oil

I've dropped a mail to Prof. Christakis a while ago. No response yet.

For ever odd

http://www.mrp3.com/bobf/nonlinear.html

I was reading this earlier, and came here to find out about non linear thinking. The blog is... well different, and while not scientific, might provide a different insight.

So, what is it that drives the non-linear person, then, to break out of the mold and invent, create, compose, and explore? Some would call this inner drive a "disorder", and tell Johnny's mother that Johnny has 'Attention Defecit Disorder', or 'Attention Defecit Hyperactivity Disorder', as though not being able to sit through a BORING lecture without doodling, or playing with his pencil, or kicking his legs, or moving around in his seat, or scratching his nose, or SOMETHING to keep his highly active mind from going INSANE, is somehow a "deficiency" or a "disorder" or something that must be FIXED because somehow, there's something WRONG with Johnny. Or, maybe Johnny can't learn to read at school because his school uses the highly ineffective 'Look/Say' reading method (instead of phonics), which requires ROTE memorization, a method that so HORRIFIES the non-linear minded person as to prevent him from even attempting it. So, instead of being a GIFTED and CREATIVE child, Johnny is treated as though he is 'slow', or 'learning disabled', or 'Attention Deficit'.

Misdiagnosed maybe?

And, quite possibly, they are viewing the non-linear minded children (whom they do not understand) as a 'problem' instead of 'a natural part of the genetic makeup of human existence'. And so they seek to 'cure' a perceived problem, using the only means they can conceive of: Drugs.

Now while the blog is totally bias to the non-linear thinker, I would give merit to the concept of conformity in school teachings. For example it was common for left handed kids to get a belt of the stick by the Catholic schools, quoting it as "the hand of the devil" until they duly learnt to write with their right hand.

Pixie Chief

I can appreciate that the rise in the diagnosis for 'disorders' of all kinds can be alarming for some and when I read articles like this, I try very hard to separate personal issues from clinical ones and not be offended. The reality of ADHD is far from 'little Johnny couldn't sit through a boring lecture without doodling' and you would certainly not achieve a diagnosis of ADHD in Ireland with that criteria. I find it strange that disparagement of ADHD is generally applied in a school setting. That is not where the most critical issues actually arise. Yes, it is indeed characterised by a lack of focus and an ability to give attention to tasks (academic or otherwise) for what might be considered to be a normally sustained period of time. Any number of interventions can be utilised in those circumstances. What people tend not to discuss are the dangers of difficulties controlling implusivity in decision making, a lack of ability to enjoy activities that they like because they can't settle to it and a lack of emotional control which are often far more likely to be the reasons that a parent will seek help for their children. They will seek help because they are worried that their child will hurt themselves or their siblings, has difficulty with any level of thinking before they act and they feel out of control emotionally all the time. It is very difficult then for parents to read articles and opinion pieces firmly stating that the difficulties that their child is experiencing every day don't exist. I am right behind the idea of 'attentional capacity that varies from individual to individual' and if that were all that ADHD consisted of, I could totally agree with the posts above. But it's not all it consists of...not even close.