I know this 7-8 year old child who is prescribed 25mg of “extended-release” Adderall, which is the trade name given to a mixture of amphetamines.
What’s the deal? Does this kid really need to be stimulated from sun-up to sun-down? Doesn’t that seem a little extreme?
Is this a truly existent biological disease? Does the doctor just ask a few questions/make the patient take a multiple-choice test; or is there some sort of scan that can be done to check for abnormality?
Its my understanding that ADD is a chemical imbalance in the brain.
Proof could easily be said that the medication works on thousands of people around the world. The medication would have to be a placebo for it not to affect someones behavior.
It is somewhat of a fad these days for doctors to diagnose children with ADD at the drop of a hat. However, that doesn’t mean that it is not real for some kids. There are no “scans” that can be done to diagnose it. For a proper diagnosis to be made, a psychiatrist must do an in depth behavioral assessment. One indicator that the child has a real neurological problem is if the medication calms them down and changes their behavior to be more socially acceptable. Children without ADD obviously get more stimulated from taking stimulants. Those with ADD calm down and are able to focus more.
The evidence is overwhelming that ADHD exists. Here is one of many, many, reviews summarizing the evidence (I know that you can’t access the full text, but even the abstract is informative. And, the authors are from a reputable little university …)
Structural, biochemical, and genetic links/abnormalities have all been documented in ADHD.
Here is one link from a great web resource (CHADD). Take a peek.
[Of course, I am not saying that the diagnosis is always made appropriately … That would be for another thread, best placed in GD)
As far as I know their is no “scan” or blood test that can determine this disorder–it can only be determined by a behavioral assessment. It may start with a multiple-choice screening test to determine if there is even a possibility of ADD, but that is followed up with more pointed discussions about specific symptoms. Generally, family members are also involved to paint a better picture of the problem. Outside influences are accounted for as much as possible.
Once it is believed that there is an ADD factor, medication may be introduced to compensate for the effects. The patient is monitored and feedback is given to determine if the treatment is helping. If there is a benefit, treatment continues. Medication is just one component of the treatment, therapy and the development of coping strategies are others.
People treated for ADD do not become calmer because they are sedated. The medication just allows them to process things better and make appropriate choices. I believe the stimulates used would would have the opposite effect on those without the disorder.
er, I thought that was depression?
I’m not particularly surprised that stimulants help people concentrate…
I have some prior experience with stimulants, including amphetamines - a tolerance to the initial flood of adrenaline experienced on the first day developes rapidly; a week at most. Even at dosages similar to those prescribed by doctors, this occurs. The mental stimulation remains, but you can feel very relaxed… more so than normal, depending on the situation.
Ah, interesting… thank you…
Anyone know how I can access these studies?
Brief medical discussion of ADHD
(Note: in the two links, the persons whose brains are displayed showing brain activity in persons with or without ADHD are adults. Given the expense of P.E.T. and the use of radioactive materials, P.E.T.s are not used as a diagnostic tool to identify ADHD (particularly in children). However, the tests linked above demonstrate that ADHD is an actual physical situation within the brain.)
And this paper, “NEUROIMAGING FINDINGS IN ADHD.” contains a review of many of the studies with full references.
One recent theory on ADHD is that it stems from an underactive executive center in the brain. This executive center oversees a number of other cognitive functions and can selectively reduce their susceptibility to outside stimuli. This allows you to concentrate on one function without being disturbed by others. In an ADHD sufferer all functions are on more-or-less full alert all the time so attention flits from one to the other with very little provocation. In this model the role of drugs is to stimulate the executive function, thus putting it back in control.
I was diagnosed with ADHD back when most people had never even heard of it. It’s still a problem for me, but not nearly as bad as it used to be. So, from years of experience-
Technically the pills are stimulants. But, in an ADD brain they produce a calming effect and allow the person to think and to focus. An ADD child will behave like they’ve been chugging espresso if left unmedicated. With treatment, they are much calmer and more in control.
This is true, but what nobody has mentioned are side effects. I can’t personally speak to the current series of amphetamines since I haven’t been medicated since methylphenidate was all there was. I could concentrate better and focus on a single task more easily, yes, but “calmer and in control” should be qualified as applying to attention span. I was significantly more emotionally reactive than I had been before (among other things), which led to a series of other problems that eventually drove me to take myself off the medication.
As I see it, the disorder unquestionably exists. It is, however, very possibly overdiagnosed and undertreated. [rant]The standard technique these days in dealing with any psychological disorder with some physiological component is to dope the patient up with minimal effort spent on behavioral therapy. Many people are diagnosed as “chronic” sufferers who will need lifelong medication (great for the pharmaceutical companies) who could eventually go unmedicated after having used some form of medication as a temporary crutch – an adjunct to behavioral therapy rather than the other way around. It’s easier (and more profitable) to just slap some pills into someone and send them on their way.[/rant]
My son has been diagnosed with ADHD, and now has a preliminary diagnosis of Aspergers. The criteria for diagnosing both conditions are nearly the same, with the only differences being the severity of the symptoms. Because of this, ADHD, Aspergers and autism are slowly being seen as part of a spectrum of autistic-type behavior. Stimulants do help; they’ve helped my son for three years now with minimal side effects. His behavior off the stimulants is far worse, and he becomes unhappy because he can’t do what he wants to do.
As ticker mentioned, ADHD is a disorder of executive function, found in the pre-frontal area of the brain. The executive function allows us to focus on something to the exclusion of most other stimuli in the environment. In ADHD/Aspergers, the executive function is underactive, and in the case of ADHD, stimulants re-activate that part of the brain so that the executive function works at a more normal level. It is not as clear if this type of treatment is effective for Aspergers patients. For all three parts of the spectrum, overstimulation is common, as the executive function cannot parse or ignore all of the incoming stimuli, and these individuals are bombarded by stimulation that normal people unconsciously tune out.
ADHD patients, and to a greater degree Aspergers and autism patients, are what Newsweek called “mindblind” in an article a few years ago. This means that they cannot, or have a hard time perceiving the subtle, non-verbal cues that are a part of normal communication. They also miss some verbal cues such as tone of voice and diction. They tend take things quite literally, and jokes, sarcasm or double-entendres go right over them. Aspergers patients also may have a large vocabulary of sophisticated words, but they misuse those words because they don’t know what they mean or how they’re used.
We have tried behavior therapy for my son for two years now with no real improvement in his behavior at home or at school. Some people may benefit from it, but if a person’s interpersonal communication abilities are impared or missing, no amount of therapy is going to much good. They won’t understand what the therapist is saying, or be able to see the concept of normal behavior.
The whole concept of ADD/ADHD/ODD/PDD/Aspbergers/Autism is slowly being changed as more research is done. What has happened in the past, and still happens now, is that two different doctors can diagnose a child with two conflicting or mutually exclusive conditions based on the same symptom(s). This is because there is still a lot of confusion and lack of precision in the diagnosing criteria found in the DSM IV-R.
Vlad/Igor
This thread on ritalin and ADD should be helpful. It’s filled with cites.
The link questions the validity of one of the studies, mentioning chronic stimulant use as a confounding factor.
Have there been any human or primate studies to determine the toxicity of the various ADD/ADHD medications? The article implies that cortical atrophy can occur because of chronic stimulant use; I know that that that is the result of “huffing”, which is obviously damaging(I know someone who was pretty messed up from abusing paint).
Well, I just want to say, “a calming effect and allow the person to think and to focus” is almost always going to be the result of a low-dose of amphetamine. I don’t think something like that(already been mentioned 3 times now) can be called proof. Wouldn’t there be something non-behavioural we could observe if this truly happens?
Is there any substance that can cause the symptoms of ADD/ADHD? Studies on animals, or something similar…
Ninetypercent
I am aware that guests cannot search for past threads. This is why I provided that convenient link. That thread contains links to plenties of studies of ritalin and ADHD. The use of ritalin to treat ADHD in children has been studied heavily and throroughly.
Please read the link I provided, and the cites it contains.
[minor hijack]
I’m interested in the effects of ADD on the perception of time. Anybody got any good pointers to studies on that topic?
[/minor hijack]
I don’t know of any studies, but here’s what I came up with when I was pondering this very question when I was ten or so: there may be an effect, but how could you tell? The perceptual measurement of a certain amount of elapsed time is always defined in terms of previously perceived amounts of elapsed time.
As a clearer analogy, how do I know what you see when you see a red object? Yes, we agree that it is “red”, but each of us is comparing to previous examples of red objects. It is conceivable that were I to get a raw “sensation” feed from your brain I’d find the sensation you call “red” I’d call “green”. The problem is this doesn’t seem to be at all possible. The best I can do in describing a color sensation is to compare it to others, and all information about qualia is lost.
IMHO, the diagnosis of all phsychiatric disorders is highly subjective and is dependent on the skill and experience of the diagnostician. ADD, ADHD, and my favorite, Bipolar Disorder are the diagnoses de jour, so we see a lot more of them every day. Life would be easier if they could stick a guage up your ass and say, "You are crazy, take these."but they can’t. Doctors must rely on actually asking questions to their patients or the patient’s parents and have faith that the answers they get are honest and unbiased. Then, too often, after a diagnosis has been made they throw pills after the problem rather than putting an emphasis on counselling and teaching the patients how to deal with the problem. This might improve if insurance covered counselling.
Well luckysevens according to the pharmecuetical company ads, all phsychiatric conditions are chemical imbalances in the brain.
Tell people what time it is, wait for a while, and ask them what time they think it is.
When I worked in hospital labs and had to spin specimens down in a centrifuge for 10 minutes, I was able to learn how long 10 minutes was. I could guess the end of 10 minutes from a random starting point within about 10 seconds. That has also allowed me to be able to accurately gauge longer periods of time to within about 2 minutes, unless I’m insanely distracted by something(s). My son, on the other hand, has a very poor ability to judge passage of time or time to a deadline. I think time for him is a number on a digital clock face, or the positions of the hands of an analog clock. I don’t think he perceives time as a quantity as much as he perceives time as one event following another. He lives very much in the present, with the past an irrelevant memory not worth bothering with and the future an abstraction that will arrive sometime and has little to do with now. He is slowly learning to prepare for the future, but only with concrete events that we repeat often.
Pharmaceutical companies love the words “chemical imbalance” because that makes them relevant. However, with the autistic spectrum disorders the problem seems to be neural organization, or a physical problem rather than the far more sexy “chemical imbalance.”
Vlad/Igor