Believe I have ADD. See GP or psychiatrist

[Black Octagon]

the concept of 'overdiagnosis' of ADHD is not a valid one. diagnosis is (in the most part) based upon meeting certain criteria set down in DSM-IV, a manual produced in the states. if a person meets enough of the criteria then they 'have' ADHD. there is no 'test' as such to diagnose this condition, it is a clinical diagnosis which means it is based upon observations made by the clinician (psychiatrist/GP) and from collateral information from school teachers/parents etc.

Although I take your point, diagnosis procedures in the US are not consistent throughout the Western world. Here in Australia there certainly is a 'test' to diagnose ADHD. In fact, one of my best friends' doctor (the friend has ADHD) makes him undergo comprehensive brain scans to examine brain activity under study conditions, EVERY time he wants a repeat for his ritalin prescription.

Just because a lot of doctors out there seem willing to prescribe ADHD medication without asking too many questions does NOT mean that more comprehensive diagnosis testing is unavailable. Thus one could argue that the 'overdiagnosis' of ADHD may be directly related to (and reflected in) the fact that such comprehensive tests are not typically used.

So, we mustn't forget that the so-called 'overdiagnosis' of ADHD is a trend that has been documented throughout the Western world and NOT just the US (although the explosion in medication prescriptions during the 1990s was particularly significant there). While methods of diagnosis in the US could certainly be improved, this does not make the concept of overdiagnosis 'invalid.'

 

[stepchild]

Although I take your point, diagnosis procedures in the US are not consistent throughout the Western world. Here in Australia there certainly is a 'test' to diagnose ADHD. In fact, one of my best friends' doctor (the friend has ADHD) makes him undergo comprehensive brain scans to examine brain activity under study conditions, EVERY time he wants a repeat for his ritalin prescription.

Just because a lot of doctors out there seem willing to prescribe ADHD medication without asking too many questions does NOT mean that more comprehensive diagnosis testing is unavailable. Thus one could argue that the 'overdiagnosis' of ADHD may be directly related to (and reflected in) the fact that such comprehensive tests are not typically used.

So, we mustn't forget that the so-called 'overdiagnosis' of ADHD is a trend that has been documented throughout the Western world and NOT just the US (although the explosion in medication prescriptions during the 1990s was particularly significant there). While methods of diagnosis in the US could certainly be improved, this does not make the concept of overdiagnosis 'invalid.'

This is the third time I have attempted to reply to this post and each time this page has locked up so I will be brief!

I don’t 100% agree with your post, what do you mean by brain scan? Brain scans can be only three things (four if you include PET scanning which I wont): CT, MRI or EEG, none of which have shown any diagnostic value in ADHD. 5% of children with ADHD show some EEG abnormalities but clearly 95% don’t, plus, these abnormalities may also be found in ‘normal’ individuals. EEG may occasionally be included in a diagnostic workup of a child with suspected ADHD if they give a history of seizures etc or the clinician suspects another neurological problem which may be contributing to the ADHD picture

I feel sorry for your mate who has to undergo a ‘brain scan’ every time he wants a prescription. (I also feel sorry for tax payers cos these tests aren’t cheap)

Does anyone else have to undergo any tests each time they need a repeat for ADHD meds?

ps what is the test that is used to diagnose ADHD that you refer to? is this the same test that your mate has to do each time he wants a repeat?

 

[Black Octagon]

^Yeah by 'test' i was referring to the brain scans my friend has to go through. I'm not entirely sure what kind of scan his doctor gives him, but as far as I know quite a few brain imaging methods have been used over the years in the effort to diagnose ADHD. These methods include MRI, CT, SPECT, and PET. I have no idea what EEG is. While it's true that there are deep divisions in the medical community as to how valuable such scans are in diagnosing ADHD, I personally think you're being a little over-critical when you make blanket statements like "none of which have shown any diagnostic value in ADHD." I say this simply because 'diagnostic value' is such a subjective thing in the first place. How does one measure 'diagnostic value' for ADHD when the alternative to such scans, as you mentioned, are the subjective criteria of the DSM-IV-TR?

I'm far from an expert in such things and barely understand the differences between these types of brain scans. But I do know that the basic idea is to examine activity in areas of the brain when the subject is under 'study conditions.' In particular, the scans look to measure activity in the frontal lobes of the cerebrum, the corpus callosum, the basal ganglia, and the cerebellum.

Despite the deep reservations that some in the medical community have with this method of diagnosis, I do know for a fact that my friend has always shown below average activity in some of these regions of the brain, and that when ritalin is administered, the activity is restored to 'normal' levels. I'll ask him what specific scans he's had done.

I should probably also mention that my friend's doctor has never relied solely on the scans. The type of criteria set out in the DSM-IV-TR have also been a major part, but I guess this particular doctor is particularly tight with the ritalin prescriptions.

 

[rm2x]

Do you have ADD? Coz if not, I don't think you have the experience necessary to give such advice.
It's a pretty difficult thing to overcome... I'm incredibly lucky that my problems are improving as I overcome my CFS... it must be an awful thing to have since childhood.

I have ADHD. And I must admit that it can be abitch at times, my school years were me runnng amok and whatnot.
But Sliip is right, embrace it! The energy that we get from it is amazing at times, it also makes our personalities shine (good for being a sales person).
ANy condition of the brain sucks, and some people don't understand why we can't pick up things as quickly as other people, but fuck them I say!

The ability to see things in the whole as opposed to from just one side is one of it's blessings

The best way to get a diagnosis is go for a brainscan on top of seeing a shrink

 

[BigTrancer]

There is one relatively new, and rapidly evolving research imaging technique that is an offshoot of magnetic resonance imaging (MRI). It is called diffusion tensor imaging (DTI) or somtimes diffusion tensor visualisation for MRI data (DT-MRI). MRI essentially uses a radio frequency field to cause water molecules to vibrate, and then provides a map of the distribution of water atoms in the tissues by measuring the vibration, providing an excellent representation of soft tissues. DTI probes matter on a scale well beyong normal imaging by essentially mapping the diffusion of water within the tissues - this has been shown to provide information about the connectivity and movement of water within the white matter in the brain. So-called 'fiber tracking' reveals important information about neurocognitive networks, and may improve our understanding of brain function.

This may be helpful in giving more information about how ADHD works in the future - but researchers are guarded about the chance of developing a diagnosis tool... see the following article:

While ADHD is typically described as a chemical imbalance, Ashtari says she may have found a clue that helps explain physical differences in ADHD children's brains. Building on previous research on brain abnormalities in ADHD kids, Ashtari chose a new MRI-based technique called diffusion tensor imaging (DTI) to look at the white matter (which is composed of nerve fibers) in children's brains in more detail. DTI tracks water motion along the fibers that connect brain parts and transmit and receive information. After scanning 18 ADHD-diagnosed kids and 15 children without ADHD, she compared the structure and function of fibers in each group's brains, and found that "the motion of the water, the way it should be in normal controls, is not in ADHD kids."

Ashtari says she found abnormality in the fiber pathways in the frontal cortex, basal ganglia, brain stem and cerebellum—areas that are involved in regulating attention, impulsive behavior, motor activity, and inhibition, which are all related to ADHD symptoms. She believes they may form a key communication circuit that may be malfunctioning in ADHD kids. "When you actually literally connect the dots, you realize that, wow, maybe we're actually talking about a specific circuit in the brain that connects the front and the back of the brain," she says. "All these spots amount to a specific circuit. So the circuit is not only in one area that it shows abnormality, [but] along the path of it, in several areas, we see the abnormalities."

Ashtari says her study is also in the initial phases of replicating existing research that shows how ADHD medication might help normalize the brain. She also stresses that her research won't diagnose individual cases of ADHD. "This study does not help to diagnose a kid," she says. "This study is just tip of iceberg to help to understand the involvement of brain in the ADHD kids and it's just the beginning and our hope is to be able one day to have the tools to put the kids in the MRI and diagnose them. That is our goal, but we're not there yet."

From:http://www.sciencentral.com/articles/view.php3?type=article&article_id=218392460

BigTrancer

 

[Black Octagon]

^ Good stuff Big Trancer, that sounds like it could lead to some very interesting further studies.

Incidentally, I just spoke to my friend. He has no idea what his brain scans are called but it turns out that his doctor is using them for research (rather than diagnostic purposes). Turns out the doctor is on some grant scheme from the Commonwealth Government to use brain imaging on proven ADHD patients (with their consent of course) to try and better understand how ADHD might work.

My friend is also fairly sure that he's been given more than one type of test in the past, so it's possible that the doctor is trying to compare the effectiveness of different brain imaging techniques.

So I guess this is where I retract my earlier remarks about there being a 'test' for diagnosing ADHD. Stepchild was on the money in the first place.

But this brings us back to some of the original issues of this thread. If ADHD diagnosis is so (seemingly) arbitrary, based as it is on a set of subjective criteria (like symptoms that may be caused by conditions other than ADHD), what does one do if they suspect they might have it? It would appear that if this is in fact a substantive disorder, then we don't yet fully understand this disorder, or how to differentiate between it and conditions with similar symptoms. Moreover, there seems to be significant grey area between individual 'medicalised' cases and what might possibly be relegated to socio-cultural factors (e.g. recreational drug culture, the intensified penetration into our schooling systems of the imperatives of commerce, etc.). Where does that leave the confused individual? Our doctors can provide limited (though certainly valuable) help, but as things stand I'd be very wary of any medical practitioner who claims to be an 'expert' in ADHD.

Thoughts, anyone?

 

[stepchild]

Big Trancer, I remember reading that article and it does look interesting but from the people I have spoken to I get the impression that it is a long way off from being used in the mainstream. I believe that paper was only presented last year?

Black Octagon, I completely understand your confusion with the diagnostic techniques in ADHD. Making a diagnosis in any field of med is not always easy and there are many ways to go about it. Most simply, a positive test reveals the diagnosis (although this is not always so simple as one must consider the sensitivity and specificity of the test); other times it is a diagnosis of exclusion, ie, exclude everything else it could be; sometimes it is what is known as a clinical diagnosis, ie, the doctor looks at all the signs and symptoms, realises it fits a specific pattern and makes the diagnosis, without the use of tests, mainly because there aren’t any available. ADHD fits into this category. With all of these methods mistakes are made.

With ADHD (and many other conditions), a retrospective diagnostic technique is often used to confirm or exclude a diagnosis. It involves monitoring the efficacy of treatment. Taking ADHD as an example, if a clinician suspects an individual has this condition they will most often be started on some meds plus some behavioural therapy and perhaps some counselling. If, after 6 months, this person finds themselves performing better at school, marks increase, social skills begin to improve etc etc we can say, by our current understanding, this person was more likely to have had ADHD because the treatment worked. In a way, this is a little flawed as we cant prove they had the condition but my point of this whole diatribe is, does it matter? The facts are that there are a group of people out there that are underperforming across a range of situations, particularly school which as we know has serious implications. No matter if there is or is not a neuro-biochemical imbalance; we have found a treatment that works, one that dramatically improves outcomes for the majority of people with this ‘condition’.

the DSM-IV criteria allow us to identify these people at an early age and start appropriate treatment to have maximal positive outcomes. for all we know, we may in fact be grouping a large group of people together with fundamentally different neuro-biochemical problems and giving them the same treatment but that is okay as it happens all the time in medicine, plus it is working (if meds are taken properly plus combined with behavioural therapy etc)

Black Octagon, I hope this has gone some way to sorting the ADHD thing out in your head. I don’t pretend to be an expert but I do have some good first hand experience in the field

just quickly, with regards to other circumstances producing an ADHD picture (ie drug use, family life) it is very important for the clinician to take a thorough history to look for any of these things. i dont know the figures on such personal issues causes an ADHD picture (if it happens at all) but i would imagine an experienced paediatrician etc that perhaps takes a full history, starts some treatment which then fails would certainly be looking for some other causes (ie drug use) and then will move on to dealing with those issues appropriately

 

[Black Octagon]

Thanks stepchild, I found that very informative. I've never studied medicine so my knowledge of such things are limited to what I can find and understand on the internet.

I just have one question about something you said, though:

With ADHD (and many other conditions), a retrospective diagnostic technique is often used to confirm or exclude a diagnosis. It involves monitoring the efficacy of treatment. Taking ADHD as an example, if a clinician suspects an individual has this condition they will most often be started on some meds plus some behavioural therapy and perhaps some counselling. If, after 6 months, this person finds themselves performing better at school, marks increase, social skills begin to improve etc etc we can say, by our current understanding, this person was more likely to have had ADHD because the treatment worked.

This seems strange to me. "If after 6 months, this person finds themselves performing better at school, marks increase, social skils begin to improve etc. etc. we can say that, by our current understanding, this person was more likely to have had ADHD because the treatment worked." But won't a person's grades most likely improve anyway (ie. whether or not they have ADHD) if they start taking methylphenidate regularly? As far as I know I do not have ADHD but have often used methylphenidate for study purposes and I am quite sure that if I were to use it continually my 'performance' would improve. But that doesn't mean I have or have ever had ADHD!

Or maybe I'm wrong about this. Backindauk claimed earlier in this thread that ADHD medications only 'work' on people with the disorder (but he/she has since been absent from this thread). It sounds like a weird concept to me, but if it's true then maybe I have ADHD (which would be very nice if you know what I mean!)

But yeah, my basic point is this: just because a medication 'improves' a person in some area over a 6 month period doesn't necessarily mean that they had a relevant condition before starting medication. I have a friend who's been taking antidepressants recreationally for about 18 months now and she loves them. She's very happy and carefree these days, but that doesn't mean that she has ever suffered from depression.

Or am I just way off the mark here?

 

[phase_dancer]

It's nothing new that students often take stimulants to enable longer study hours that hopefully eventuates in better grades. But, there are normally limits to this, and some may find that overdoing it actually works the other way i.e. results in lower grades due to memory/ recall impairment.

 

[stepchild]

Black Octagon, you are right, i was being a little lazy in answering the question, i should have elaborated a little more. in assessing someone after giving a course of meds they look for a lot more than just their grades etc, i was just using that as an example that perhaps people would be able to relate to. in fact, giving dexies or ritalin to people who dont have ADHD will not have the same effect on people with ADHD. take simple things like not being able to wait in line, wait for your turn at a game or sitting still in class (remember we are mainly talking about school age kids), in children with ADHD they will find themselves being able to perform these tasks better with ADHD meds than without. However, people without ADHD who are taking ADHD meds, will probably find the opposite as they often (especially dexies) increase energy levels and impatience.

A common myth about ADHD meds is that they improve work effort in children with ADHD because they feel more motivated/stimulated (as it may do in those without the condition) and hence result in better grades. In fact, it is the reduction in all the inattentive/hyperactive components of ADHD that allow a better application to school tasks etc which then hopefully results in better marks. it is a little counter-intuitive that these drugs can have almost opposite effects on two sets of people, which is in fact one of the strongest arguments for the existence of ADHD and relates back to what i was saying about retrospective diagnosis

Backindauk is right in that ADHD meds only ‘work’ in the way they were intended on people with ADHD, however, people have found that taking these meds when you don’t have ADHD does help some people study for longer periods of time, but this is not universal, just as many people who tell me they can study all night tell me they just feel like going to the pub!

With regards to your friend who takes anti-depressants, it has been shown quite conclusively that these drugs do not improve mood in those who are not depressed. so im not so sure about the recreational use of the anti-depressants, perhaps she is enjoying one of the many wonders of the mind which often manifests as the placebo effect!

Also, tell her to go easy, you can OD on anti-depressants, even SSRIs

phase_dancer is absolutely right about overdoing stimulants, you need to sleep for a reason, that’s what I always thought when I was studying, if I was tired I would say bugger it, i'm going to bed!

 

[Black Octagon]

I see. But then again, there are quite few subtypes of ADHD aren't there. The stereotypical image of a child who's seeemingly always hyperactive, unable to sit still, and thus unable to focus properly in a class and homework environment is only the most 'conspicuous' one. Sorry I've forgotten the names of these subtypes, but one I do remember is called the 'inattentive subtype,' and this affects young children as well as adults. And this subtype is marked almost entirely by a difficulty in focusing for sustained periods on work due to a short attention span (as I understand it from the net). This inattentive subtype is NOT marked by things like hyperactivity and a (puerile) resistance to authority figures. So in this case, isn't it a little harder to see whether a medication like ritalin has taken its course? I mean, the desired effects of improved attention span and therefore work performance may well have happened whether or not the patient really had ADHD.