The DSM criteria are not limited to research, but they are far more useful for that purpose than in clinical practice. When I recognize depression in a patient, I don’t pull out the DSM-IV criteria for MDD and use them as a checklist; “sorry, I’d give you some Zoloft, but you only meet four of the B criteria rather than five, so you’re not majorly depressed.”
When you’re defining depression for research purposes, you have to define things a little more carefully, and imposing rigid criteria reduces subjectivity. Thus, the patient with four B criteria instead of five would not be eligible for a study of patients with MDD. (Yes, many studies use more real-world criteria like “patients whose physicians thought they were depressed”, but that creates a different sort of study–more useful in some ways, less in others.)
Psychiatrists will use the DSM-IV clinically when more precise diagnosis is helpful or to define more esoteric syndromes, but they are too specific to let treatment or no treatment rest on their precise fulfillment.
re: Strattera–I’m too tired to do a Medline search right now or to dig through the wheat vs. chaff of ADHD web sites. Here is Lilly’s page on the drug, which of course should be regarded with skepticism but can’t be too outrageously inaccurate thanks to our friends at the FDA. I know that my own shrink is using it as a first line drug now. (He’s hesitant to try me on it, since the Ritalin is working so well.) Note my misspelling in my above post, and it also seems that it can be dosed QD or BID. Even so, teachers won’t have to maintain a Ritalin Vault anymore.
Hmmm. Well, I pretty much do rely on the DSM. If a person appears to be suffering from a disorder but does not meet full criteria, I would either use the “provisional” qualifier or give a “not otherwise specified” diagnosis.
If a man is feeling a little off-base and not focusing too well, should he inject himself with a gram of speed to help him focus his attention? I think not.
IMHO, Ritalin is a great way to make money off a dysfunctional education system and a dysfunctional consumer society. I know of a program that fosters learning in children that has children able to read at three years of age. This sort of program leaves kids happy and eager to learn as they are making progress in their growth as a person. Young kids are routinely stultified in their intellectual growth and then we wonder why the act up? That such programs as I mentioned are not promoted by the authorities, while Ritalin is given wide acceptance, is testament to the fact that vested interests and political corruption carry more weight in our society than do actual solutions.
A: I have ADD, or ADHD as it is now. I think it’s very common among computer geeks. I think it has something to do with the hyperfocusing phenomena.
B: Ritalin stunted my growth, but it was very effective for the brief while it worked. It made me very unhappy, but I must have been a holy terror. On the other hand, my memory from that time is shot, and I think that may be related.
Oh, and Lander? Yes. That is, in fact, one of the defining characteristics of ADHD. ‘Speed’ actually slows us down. You know, I’ve never done actual speed, and I am vaugely curious as to how it would affect me. Anyone able to report?
Did you have a specific point, there, lander2k2?
Or were you simply voicing a generalized “I don’t like chemicals” complaint?
There has been substantial evidence provided on this thread, from sufferers of ADHD, professionals working with sufferers of ADHD, and links to clinical information about ADHD, indicating that there is a specific issue with brain function that goes way beyond “boredom” and is manifested in physical phenomena that can actually be watched through P.E.T. Scans, MRIs, and other methods of testing.
So where does teaching kids to read at three overcome any of those issues? (And I do not oppose teaching yoing children to read, but my son would throw down a book he loved in frustration that he could not sit still long enough to finish a page.)
lander2k2-at three and four years old, I went to preschool, and attended ballet lessons. It didn’t matter HOW focused I was on intellectual or physical pursuits-I STILL could not function properly.
Yes, sir I did have specific point. You know I was listening to a guy on the radio earlier who referred to the brain circuitry that seems to remove things from sensory perception that people don’t want to see/hear. This reminded me of that. My specific point was right there for you to read. “IMHO, Ritalin is a great way to make money off a dysfunctional education system and a dysfunctional consumer society.” (Cut and pasted without any editing.)
And, no, I don’t have any real problem with chemicals per se. They’re great for degreasing engines and unclogging drains. They’re even useful for treating human conditions at times. However, when labels for human conditions are invented so as to make billions of $$$ selling chemicals, then I have a problem with those chemicals. Is that a specific enough complaint for you?
**
Your “evidence” consists of sufferers of: Sufferers with real conditions that have been diagnosed in such a way that pharmaceutical corporations can profit from them (how can these sufferers evaluate their conditions other than how the professionals have explained them?); professionals that make a great deal of money treating these patients and will tell you anything that keeps their bank account healthy; and clinical information that amounts to drug company propaganda that will go to extreme lengths to protect their multi-billion dollar industry. This specific issue that you say goes way beyond boredom, has been built around fiction and pseudo-science and will spin reams of drivel to convince you that someone who is just not being taught effectively has a “chemical imbalance in the brain.”
A method of education that is effective enough to have children reading at three and, in general, reaching educational levels at or beyond twelve year olds stuck in traditional schools, promotes kids’ natural energetic focus and drive. A child’s inherent purpose is to learn about their world so that they can get a long in it. If you stultify their efforts to do so, of course they are going to lose focus and concentration—their purpose to learn has been smothered!
(Maybe your sons’ teachers should be put on drugs, rather than your son.)
I’m sorry. I won’t argue with you about your condition. If you are convinced that you need drugs to deal with your condition, then I have no interest in trying to talk you out of it. It would serve no useful end for me to try and discuss your condition with you here in this forum.
If, on the other hand, you wish to take up some objective point, go ahead.
One phrase that I found curiously absent from this thread is “paradoxical effect.” An ADD person can actually calm down by taking a stimulant. My girlfriend, who is severely ADD, usually washes a ritalin down with a cup of coffee before going to bed. It helps her to concentrate on sleep. Amazingly, her shrink doesn’t get this.
It would seem to me that because of this, overprescription would sort the ADD kids from the non-ADD ones pretty effectively.
So you are sticking your fingers in your ears and saying nanananana to any form of evidence different than some guy you heard on the radio, whom you don’t cite or name btw and suggesting that people who live with ADHD or treat it every day are not being objecive. Yes many studies come from drug companies. The theory that they have a vested interest in the drugs being used falls flat though, when you concider that Ritalin, still the most prescribed is not still pattented. No drug company is going to pay for research to get some other drug company money.
Pay attention we are going to say it one more time. ADHD is not just high energy kids. It is not just brats, although sometimes it can be perceived to be by outsiders. I am not a doctor but i can see the difference in my daughter. It has nothing to do with not wanting to behave, it has to do with plain not having any impulse control.
This is empirical evidedence, but my ADHD child was flunked first grade without Ritilan. She wouldn’t try new things like learning to ride a bike because I think she had gotten so used to failing she didn’t want to add something else to fail at. With it she is doing pretty well in a french immersion program and reading both french and english above grade level. With medication she still needs more supervision than other children her age and she needs quite a lot of structure to her day. She doesn’t deal with transitions well. She enjoys reading and running and building facinating intricate patterns out of lego. Mornings are disasterous. Because my child who can read French and English and Spend hours drawing pictures can not concentrate long enough to put her pants on without being reminded three times in the middle of the process. I have also gotten a call from her teacher on a morning that I forgot. She knew when the medication was missed and it was affecting her class room. There were also a couple of times that she didn’t take the pill and hid it. I spent the whole day yelling at her and nagging her. I found the pill later. If you don’t think we get chances to see what no medication is like everyday.
I am going to leap to my own conclusions that you think maybe we all are spoil the rod sorts or some such idiocy. I spanked before ritalin. I did time outs. I did standing over the kid and reminding and nagging and firmness and all of it. It didn’t work and was never going to work. I would love there to be a day when she won’t need to take medication. I want her to grow up living up to as much of her potential as possible. That is my job as a parent. For right now, that has to include medication.
So you are sticking your fingers in your ears and saying nanananana to any form of evidence different than some guy you heard on the radio, whom you don’t cite or name btw and suggesting that people who live with ADHD or treat it every day are not being objecive. Yes many studies come from drug companies. The theory that they have a vested interest in the drugs being used falls flat though, when you concider that Ritalin, still the most prescribed is not still pattented. No drug company is going to pay for research to get some other drug company money.
Pay attention we are going to say it one more time. ADHD is not just high energy kids. It is not just brats, although sometimes it can be perceived to be by outsiders. I am not a doctor but i can see the difference in my daughter. It has nothing to do with not wanting to behave, it has to do with plain not having any impulse control.
This is empirical evidedence, but my ADHD child was flunked first grade without Ritilan. She wouldn’t try new things like learning to ride a bike because I think she had gotten so used to failing she didn’t want to add something else to fail at. With it she is doing pretty well in a french immersion program and reading both french and english above grade level. With medication she still needs more supervision than other children her age and she needs quite a lot of structure to her day. She doesn’t deal with transitions well. She enjoys reading and running and building facinating intricate patterns out of lego. Mornings are disasterous. Because my child who can read French and English and Spend hours drawing pictures can not concentrate long enough to put her pants on without being reminded three times in the middle of the process. I have also gotten a call from her teacher on a morning that I forgot. She knew when the medication was missed and it was affecting her class room. There were also a couple of times that she didn’t take the pill and hid it. I spent the whole day yelling at her and nagging her. I found the pill later. If you don’t think we get chances to see what no medication is like everyday.
I am going to leap to my own conclusions that you think maybe we all are spoil the rod sorts or some such idiocy. I spanked before ritalin, I havent in the three years since she started being medicated. I did time outs. I did standing over the kid and reminding and nagging and firmness and all of it. I yelled I screamed, I took away privilages, I rewarded for good behavior. It didn’t work and was never going to work. I would love there to be a day when she won’t need to take medication. I want her to grow up living up to as much of her potential as possible. That is my job as a parent. For right now, that has to include medication.
In my case, this is absolutely untrue. I make $0 more for diagnosing a child with ADHD versus diagnosing a child without ADHD. Typically, a psychologist will not be reimbursed by third party providers for treatment of ADHD, despite the benefits that parents and children have been shown to have from psychosocial and behavioral treatments.
As a researcher, I receive no attention for publishing evidence that ADHD exists. However, if I were able to find evidence that it did not exist, I would instantly jump to the head of the pack, because my work would be novel.
Your rant is nothing more than that; you have an axe to grind but nothing useful to contribute. You are noisy about your beliefs regarding the fiction of ADHD and ritalin, and in that sense, there is nothing novel about you, either.
So, basically, you simply have an unthinking opposition to the use of chemistry. (I hope you never have a kid with diabetes.)
Note that the studies I mentioned were not simply studies by chemical companies on the results of their products. I specifically linked to a summary of several independent studies that showed that there was a physical difference in brain function among sufferers of ADHD and that that physical symptoms were mitigated by the administration of various medicines.
(And given that you do not know the quality of my son’s teacher (who was superb), you are clearly following an agenda of promoting ignorance supported by nothing more than ad hominem attacks.)
The brains scan results are an effect, not a cause. Would a person who is distressed by, say, the sudden loss of a loved one have a different brain scan result from a normal person not under emotional stress?
I’ll see if I can explain with an analogy. If your car began to lose power and, at the same time, white smoke began to be emitted from the exhaust pipe, you might deduce that the smoke is the cause of the loss in power of the car. Anyone who understands engines would suspect that the piston rings were damaged or worn. However, if a company wanted to sell a new exhaust filter that removed smoke from the exhaust, then they might hire a research lab to come up with all sorts of “scientific” reasons why the smoke itself was the culprit.
Before you start buying the research results proving the existence of ADD and ADHD as brain disorders, you might want to consider who contracted the research out.
I’m sorry, I’m missing the point of your quip. I only listen to Rush for comic relief. If there was ever a classic example of a man who hears only what he wants to hear (which is invariably that Clinton is evil and that Bush is divine) then he is it. Maybe you could explain what you meant.
I think you have indeed opened a gaping hole in the whole “science” of psychopharmacology. It may well be a complete myth that only ADD and ADHD sufferers are effected by Ritalin in a certain way. How would we know since only ADD and ADHD sufferers ever take the stuff? I would hazard a guess that Ritalin would act as a downer for any kid. And I would bet that a Ritalin and a coffee would put any female to sleep of a similar body-weight to your girlfriend. Here’s why. Drugs in small doses usually give someone heightened alertness or energy. If you continue to feed the drug into the body it reaches a point where it becomes oppressive to the system and slows the body down. Give someone a few beers and he is the life of the party. By his fifteenth beer the same guy will not be so energetic—he’ll be lucky to be awake. Children are small. The amphetamines that would usually give someone a rush, on a young body, overwhelm the system and slow them down, making them more manageable and seemingly more attentive. Your girlfriend, as her body has grown, probably needed an extra kick to overwhelm her system and the coffee provides that extra needed kick to slow her down enough to sleep. Even coffee if taken in sufficient quantity (or in combination with another drug) will put you to sleep. It is the body’s reaction to a mild toxic shock.
That her shrink doesn’t get this is indicative of their “science.” We’re talking about a “science” that says, “If someone is having emotional difficulties, give them a drug.” Does no-one question the common sense behind that idea?