Part 2 increase in ADHD dx

(If you like the blog please spread the word and sign up to follow it on this site or on facebook. If you would like a question answered or to set up a counseling appointment send me an e-mail)

Part 2 Increased diagnosis and ADHD

“Blindness is not a disability in the dark.” I do not know whose quote this is but it isn't mine so I won't claim it. In order to begin to understand ADHD we must know the difference between a symptom and a disorder. Just because someone has a symptom it is not a disorder unless it impairs their functioning in some way. In addition, a person cannot be diagnosed with a disorder if their symptoms are better explained by behavior, something in the environment, or another disorder.

Attention deficit disorder (ADHD) is the most over and under diagnosed disorder in our society today. How can this be? The over and under is all about the presence or absence of the H in ADHD: Hyperactivity. Not every child who is hyperactive has ADHD, but most of them get diagnosed with it because the treatment for ADHD (counseling to improve organization and stimulant medication) tends to improve performance in almost anyone.

A child might be hyperactive for many reasons, and if this reason is related to environment (trauma, family instability, poor diet...) it would be unethical to medicate them for a disorder they don't have. So why is that the first choices of parents and doctors? Because it often works, and it is easier to blame a problem on the internal biology of a child than change the dynamics of a family. Also there is very little to lose by trying an ADHD medication. They are in and out of the system in 24 hours and are not physically addictive. Is it any wonder that so many people say why not, rather than why when it comes to medicating hyperactive kids?

But what about the other part? What if you are just inattentive? How can you tell the difference between someone who is inattentive and someone who is just lazy? It is really really hard. Especially when you consider how likely it would be to give up and become lazy if you had a much more difficult time paying attention than your class chums and everyone was calling you dumb.

But don't we all have difficulty paying attention sometimes? Yes. Every person in the world meets some of the criteria for ADHD some of the time. In fact there are many people who meet most of the criteria almost all of the time and yet they would not qualify for a diagnosis? Why? Because no matter how hyper or inattentive you are if it does not cause a problem in your functioning then it is not a disorder.

Highly intelligent people often don't get diagnosed with things like ADHD or even dyslexia until late high school or college because up to that point they have found strategies that allow them to succeed in their own way.

People with ADHD are often resistant to doing things any way but their own, they don't know why, but when we slow them down in counseling and explore it they have usually determined that the “typical” way of doing things won't work for them.

Contrary to popular belief people do not out grow ADHD. They just find strategies that work for them in helping them negotiate their environment. Often once people leave the academic world they no longer need medication, just as some people only need glasses for reading.

ADHD is real. It is as genetically linked as height but up until the 1970's we called it things like “minimal brain dysfunction.” and so parents often do not realize that they had it themselves until they go to the doctor to get their child diagnosed.

Today about 1 in 25 children are diagnosed with ADHD, but if the diagnostic trend continues at its current pace I believe that number will go to 1 in 10. My experience suggests that this will be close to the actual rate but 50% of people diagnosed with ADHD will not actually have it, and 50% of people who have it will not be diagnosed.

ADHD is more prevelant now because we live in a society of near constant stimuli so when the demand for extended concentration is placed upon a mind that is pre-disposed toward ADHD they are going to be more likely to struggle.

People with ADHD CAN focus on certain things, like video games, or other things they like. This does not mean they do not have the disorder. In fact, people with ADHD tend to have hypo (not enough) and hyper (too much) focus, when confronted with different stimuli.

The good news is ADHD is extremely treatable and there are very few side effects from treatment. If you think you or your child is suffering from ADHD go to a qualified professional and begin the process of diagnosis. Beware any one who does not at least give you a checklist to be filled out by parents, teachers, and the student. If a person suffers from bi-polar disorder the stimulant medication usually used for ADHD can lead to highly agitated behavior and that is why all medications need to be prescribed and reviewed by a doctor.

A final warning. Many people with ADHD try to self medicate using marijuana. This is the WORST thing you could do. A brain with ADHD is like a heavily loaded truck trying to drive up a hill. It doesn't have quite the energy so the engine is whining and straining. A stimulant medication is like a burst of turbo boost to get it over the hill. Marijuana is like suddenly throwing the truck in reverse. Sure the engine stops straining, but we never get over the hill and that shift of gears will make it harder to get over the hill the next time.

Is America going crazy?

Question: Is it just me or does it seem like everyone is diagnosed with ADHD, Depression, Bi-Polar, or Autism? Do you think it is because professionals are better at recognizing the symptoms or have we turned into a society that needs an excuse for everything? Or is there something in the environment that is making us crazy?

This is such a good question that I think I will have to do a separate post for each disorder, and a general one to start on diagnosis.

Part 1: General increase in mental health disorder diagnosis in our society.

The short answer to your question is...yes. I think professionals are far better at recognizing symptoms and since the introduction of better diagnostic tools (like the DSM III, IV, and IV tr) more professionals are speaking the same language and using the same objective criteria to make a diagnosis.

A diagnosis is not a label that you stick on someone and say, “Ok we're done.” It is a suggestion for a course of treatment. The DSM (big book of disorders) is not a menu. Any person looking through it would find at least 10 disorders they thought they had by going through the check lists. That is not how it is supposed to work.

The way it is supposed to work is a licensed professional meets with a client/patient and they get the feeling, based on their experience and the symptoms they observe, that this person may have a particular disorder. Then they check the DSM to make sure there is nothing that they missed, so they don't try a form of treatment that might be more harmful than helpful.

Assessment and Diagnosis are never complete, they are a statement of the best course of treatment so far based on the information we have. If the symptoms go away there is a pretty good chance the diagnosis was correct.

Does our society just need an excuse for everything? I think our society needs a reason for everything, and wants a cure for everything. We are taught that if we feel discomfort something has gone wrong and we ought to diagnose and cure the problem. Diagnosis is not an excuse, it is a reason, and suggests a course of treatment, but there are many people who use a diagnosis as an excuse.

Also I think that while every disorder in the book has been around for centuries (just read Shakespeare or Greek mythology) our environment lends itself to mental illness in a way it never has before.

Why? Kids today have everything right? I mean it is so easy for them, they don't have to work for anything what do they have to be stressed about?

Every mental health disorder is made worse by (and some are caused by) stress. Stress comes from having to make choices and decisions. Freedom and choices are wonderful things that we value, but when you have the freedom to choose there is a possibility that you might choose wrong and that knowledge grinds people down.

Our society has changed more in the last 150 years than it had in the 10,000 years prior to that. I am glad to live in our world today, but with each passing year as we give our children more leisure, freedom, and choices we pile the stress on. It is hard to have a nervous break down when you are a peasant who doesn't have time to worry about anything more than whether or not you are going to have enough to eat.

Finally there is something biological occurring in our present environment which cannot be denied. The increase in peanut allergies in the last generation requires a physical explanation. As does the increase in Aspergers and ASDs (autism spectrum disorders), these disorders exist. We do not know why yet but it is certainly not a failure of parenting, or over protective mommies making up excuses for the children.

The end result is we have a lot of people who are struggling. The good news is we can help and we are getting better at it all the time. I believe we are in the infancy of our understanding and treatment of metal health disorders. In 50 years as our understanding of the brain matures they will look back at our techniques as we do the blood letting of George Washington's generation.