Friday, July 20, 2007

Sometimes the mind, for reasons we don't necessarily understand, just decides to go to the store for a quart of milk.
--Diane Frolov and Andrew Schneider, Northern Exposure, Three Doctors, 1993
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Well as this is a major element in my newly chosen field, I have more than a few words about Attention-Deficit/Hyperactivity Disorder, or ADHD (and some strong opinions).
I have met dozens of kids diagnosed with ADHD. Out of the whole bunch only two were correctly labeled. These two responded to medication. When they imbibed caffeine, they became calmer and quieter. The effect of speeding up those portions of the brain that were affected was so obvious! As a foster parent I have heard tale of many children who stop taking their drugs and their energy level decreases, they are more ordered, and have longer attention spans.

Current research hypothesizes that ADHD is a result of a portion of the brain that has significantly less blood flow. Think of this as slowing down the brain engine because it has less fuel to run. By adding chemicals that cause vasodilatation and increased activity, these starved engine parts get a boost, thus relieving some of the symptoms of ADHD. The actual cause is linked to genetics and a propensity for dopamine transporters to be in excess in certain parts of the brain.

The problem is not with the kids, but with the parents, schools, and doctors. Many school systems are putting enormous pressure on parents to seek medical attention for ADHD. In some cases parents are being told that their child will not be allowed back into school (which is a huge violation of legal rights and ethical boundaries). I don't want to burden the teachers with chaos or vile children. The teachers are responding to crisis, and their job is hard enough without adding doctor to the list.

As a country we are putting diagnostic and essentially prescription power into the hands of teachers. The same teachers who are overworked, underpaid, and pressed into extraordinary single parent roles for 30 kids. If it were me I would want every tool in the box to maintain even the smallest degree of sanity. The teachers are responding to the issue, but I blame family doctors who can't know enough to make such a diagnosis.

Your family physician is not well equipped to diagnose ADHD. They can only take second-hand information and make a guess. Most of this information is not appropriate, as it is based all or in significant part on teacher evaluation. As a parent, I would insist on a brain scan and attention span and behavioral testing. Improper diagnosis leads to children being placed on amphetamines. There is a reason a black market exists for these drugs, should we be handing these pills out like candy?

A study done by the School of Public Health in New York found that the language used to describe kid’s behaviors was paired with the diagnostic criteria for ADHD. This means that the same syntax is used. The problem is that the kids being described were not suffering from ADHD.

While I am jabbing doctors, they need to stop pushing antibiotics for colds. Be a man and tell the parents that there is no magic pill. They may not think of you as a living deity, but then they will also stop creating MRS!
According to the Diagnostic and Statistical Manual IV-Text Revision (DSM-IV-TR), the following criteria must be met for a person to be diagnosed with Attention-Deficit / Hyperactivity Disorder.
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I - Either A or B:

A) Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

Inattention
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

B) Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsivity
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II - Some symptoms that cause impairment were present before age 7 years.
III - Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV - There must be clear evidence of significant impairment in social, school, or work functioning.
V - The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

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