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Full Version: Doctor: ADHD Does Not Exist
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Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children — and now adults — who can't live without stimulants is no solution

This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.

Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.

Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.

For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.

http://time.com/25370/doctor-adhd-does-n...?hpt=hp_t3




frat
At best ADHD is a blankey term, at worst, something far more sinister.
It's over diagnosed I didn't read that he disregarded it existed, like the title of this post.


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(04-16-2014 08:51 PM)what Wrote: [ -> ]It's over diagnosed I didn't read that he disregarded it existed, like the title of this post.


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"In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist."
sorry gimp my adhd kicked in at the wrong time again

Maybe my dyslexia is the true source of adhd. If I didn't have the numbers knocked out of me in my earlier days, I wouldn't make excuses for such poor behaviour today
I have held this position for years.

I'm sure some variant of attention disorder exists but it is extremely rare.

the rest is just kids being kids or people wanting an excuse to get brain stimulants to ace their tests perform better in the workplace.
Sedated sheep are obedient sheep.
Weed + add Drugs + ssris = why nothing is changing in the US.

people are doped out and just dont' care. and if even if they do, it's just for entertainment reasons.

This is a standard tactic used to weaken nations. The British used this to maul China. They forced opium on the Chinese and proceeded to carve the country up and destroy it.

Standard operating procedure.. except the victims are the American people.

but all in the name of FREEDOM.
people need to distinguish between ENGINEERING SCIENCE and THEORETICAL WISHY WASHY "SCIENCE"

Engineering science is why we can use computers, have bridges and reliable tools.

Theoretical wishy washy science is like evolutionary biology, origins science (evolutionary explanations) psychology, social sciences etc. where you have tons of confounding variables and synergistic effects. most of the time these guys have no idea about what they are talking about even if the methodology is rigorous.

There is nothing that can prove "chemical imbalance" theory. This stuff succeeds because western parents are lazy, are afraid to discipline due to being neutered, a lack of a father figure and also strong financial incentive for shady doctors to push mind bending drugs to people.
A great example of wishy washy science ruining lives is how they used to preach that the brain stopped developing around 18-20 years old. We now know that to be wrong. the brain is constantly making new connections and is somewhat plastic.

research neuro-plasticity. It does not mean a really dumb guy can be a genius but there is a limited flexible band for intelligence.

Also now we now know epigenetics can change gene expression through environmental or directed behavior. Studying harder may make you smarter and you pass some of that on to your kids. If you eat fat ass foods during your life and you yourself = lardass, your kid may be a lardass because your gene expression changed.

This is stuff people knew LONG AGO without scientific studies. It would make sense that if you studied a lot, you would get somewhat smarter.

Only 10-15% of the US public trusts 'scientists' these days.. so I think we are making progress.

I trust engineering science. You make something and it works. There is predictive power.

there is no predictive power with a lot of this psychological mumbo jumbo garbage science.
(04-17-2014 06:45 AM)EVILYOSHIDA Wrote: [ -> ]A great example of wishy washy science ruining lives is how they used to preach that the brain stopped developing around 18-20 years old. We now know that to be wrong. the brain is constantly making new connections and is somewhat plastic.

research neuro-plasticity. It does not mean a really dumb guy can be a genius but there is a limited flexible band for intelligence.

Also now we now know epigenetics can change gene expression through environmental or directed behavior. Studying harder may make you smarter and you pass some of that on to your kids. If you eat fat ass foods during your life and you yourself = lardass, your kid may be a lardass because your gene expression changed.

This is stuff people knew LONG AGO without scientific studies. It would make sense that if you studied a lot, you would get somewhat smarter.

Only 10-15% of the US public trusts 'scientists' these days.. so I think we are making progress.

I trust engineering science. You make something and it works. There is predictive power.

there is no predictive power with a lot of this psychological mumbo jumbo garbage science.

EY... "neuroplasticity" and "epigenetics" is part of this wishy washy science that you keep complaining about. Sorry.

Intelligence is about as genetically constrained as athleticism. Does this mean environment doesn't matter? Sure it does. But at the end of the day, some people are naturally fast, and others are slow. Practice DOES work. Yet no chinaman is ever going to become competitive with black people in sprinting, no matter how hard they practice.

There is not a shred of evidence that studying calculus while you are pregnant with your child will make your future generations smarter by altering their DNA. The whole concept is bull crap.

Sorry. How come the Japanese generation that was born to parents who were starving to death, wretchedly poor, and losing millions of lives to atomic bombings, aerial raids, etc. was the most creative and successful in Japanese history? How come Japanese baby boomers aren't all retarded?

If epigenetics works one way, it should operate the other way, as well. Parents who live in dire circumstances should produce retarded children across the board. This hasn't happened anywhere. It didn't happen to Korean War orphans, who have higher IQs than white people. It didn't happen to Americans during the Great Depression. It didn't happen to the Soviets who lost 20 million ppl and were being slaughtered by animals like the Nazis.

Where is the proof for lasting epigenetic effects on human intelligence? ZERO.



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Actually you might be right about lardass parents producing fat kids. But fat is a lot more plastic than physique or intelligence. And we understand how the casual mechanism works.

The brain is the most metabolically precious and expensive organ in the body. You should expect it to be less impervious to environmental effects. Not more.



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Quote:Intelligence is about as genetically constrained as athleticism. Does this mean environment doesn't matter? Sure it does. But at the end of the day, some people are naturally fast, and others are slow. Practice DOES work. Yet no chinaman is ever going to become competitive with black people in sprinting, no matter how hard they practice.

A skinny person can definitely bulk up or get ripped through extra effort. I defintiely believe an avg. IQ person can become above average through directed effort and study. Like I said, neuroplasticity doesn't mean anyone can be a genius through studying but that there is wiggle room for improvement.

They actually did studies on taxi drivers that were in their 30's and 40's and found that as they learned the roads of the city, certain parts of their brain got bigger and constructed more connections.

Regarding your chinaman comment.. Liu Xiang was a skinny chinaman that managed to beat all the africans at hurdles.

i predict there will be more in the future.
For example... we know that height is one of the most genetically constrained traits out there, along with IQ.

Does nutrition and disease exposure matter a lot when it comes to height? Of course. Look how much taller Asians are compared to their midget parents. The difference in height between generations living under wretched, dog shit circumstances and those who have access to optimum nutrition is roughly TWO SD (standard deviations). That's roughly 5-6 inches in height. East Asians haven't even hit their max potential yet.

We know this not just by comparing generations under wealth and poverty in Europe... but also by looking at the archaeological record. Whenever a race or culture anywhere adopts agriculture, and hence starts eating shitty plant based diets... their heights shrink by roughly 2 SD. In general the change is so rapid that it cannot be attributed to evolution. This has been observed everywhere from Egypt to China and Sri Lanka. No meat + grain based diet + exposure to disease = midget offspring.

Yet at the same time... the difference in brain size between deprived and nourished populations is only 1 SD. clearly environment matters for the brain, as well. This is exactly the outcome we might expect from evolution... knowing that humans have lackluster physique compared to most other mammals, the only way you can compete and survive in the wild is by putting all your eggs in one basket. When you look at starving kids in North Korean, they tend to have have very short and stunted arms and legs, but their heads tend to grow much closer to their genetic potential.

Of course intelligence can be modified environmentally, just like height or physique.. only not nearly to the same extent. East Asians have 15% larger brains than Australian abos. you are NEVER going to close that gap, no matter how much you tinker with education or nutrition. It is what it is.

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