My son also has somewhat complex other issues, including Arnold Chiari Malformation, low tone, and seizure disorder. It may very well be that some or all of these disorders is caused by some form of brain injury in utero. My pregnancy and it’s complications support that in my son’s case.
When you’re the parent of an “involved” child, dealing day-to-day in the most positive way is fundamental, as is learning and utilizing effective methods of discipline and supporting self-disclipine. I doubt that there are many parents who soley medicate the child without availing themselves and their families of other methods.
The posts of people that have never lived our lives yet have these radical new ideas of how to deal with it on a “psychological” basis, or with this “parenting skill” or that, do feel very patronizing and arrogant to me.
I’ll read through the cites, and do a full reply later, in the meantime
To find the best way to teach a child, you must know their abilities and limitations. That kind of information is conveyed well by labels.
I never suggested it was a hallucination. At present, just for the sake of argument, I’ll assume it’s even as useful in treating autistic children as you say it is. I questioned whether DI was relevant to this discussion. Unless these cites show (or can be reasonably argued to show) that DI is more effective treatment for ADHD, than medication combined with other therapy, than DI is NOT relevant to this discussion. It is just another school of pyschology, and discussing it is as pointless as talking about Freud’s theories.
Linking to a cite you haven’t read :dubious:
I never claimed he didn’t exist. If this thread were about autism, he’d be germaine. This thread is about ADHD. The work you did with that autistic boy is irrelevant.
And I maintain that ADHD can NOT be treated merely by teaching skills. You do need to teach the child skills. You also need to give the kid pills.
I am not talking about getting kids to “behave”. I am interested in helping them.
This being psychology, that means ‘Is behaviorism valid?’ is a GD thread of its own, and that various respectable experts will endorse every possible answer.
Children with ADHD are NOT “hard-to-manage”! They have neurochemical problems. I (and I’m going to go out on a limb and assume this applies to the other pro-medication folks in this thread) are not simply trying to control disruptive behavior. We are trying to help children.
In no way did that answer my question. But, I’ll answer yours. Idunno, ask them. Because (and this may change after I read your cites) you haven’t demonstrated that DI is useful in treating ADHD, and have generally convinced most of us you are on an anti-medication crusade and have little knowledge of the subject. And that same answer goes for the final question.
I disagree. Classification and examination of problems is helpful. The pills and ADHD therapy I (and Guinastasia) received were very helpful.
I accept other kinds of evidence. I see some fine examples of drawing conclusions not warranted by the evidence in your posts.
No argumentt here. Show me where I claimed it wasn’t.
If you can’t prove that claim, why should we act as if it is true?
I’m no chemist. But, ritalin is not ethanol. If you wan’t to prove ritalin or other meds negativetly affect the personality or cause damage to the brain, I want to see evidence.
I say again UTTER FUCKING BULLSHIT! My personality is exactly the same on the meds as off. Guinastasia has said the same. You claim that ritalin etc, change personality traits rather than treating an actual problem, I want some fucking evidence.
Well, lucky for us I’ve never heard of a reputable study finding that ritalin etc did significant harm. So, I guess that those parents who do medicate will just have to put their faith in a few decades worth of studies.
It isn’t the personal details. It’s the non sequitors and irrelevant information.
Kiminy, just to be clear, I have not said that I thought that these drugs would stifle imagination or creativity. I have said that we can’t really know what all the consequences might be. In particular, it bothers me that it is being given to children who are young enough that their brains are still developing. It also bothers me that it is so often considered to be a first resort, rather than a last one.
As to the experiences you report with your child, it may be that the techniques described in the book aren’t the right ones for him. There do exist ways to “step it up a notch”, but I don’t think that I would be the right person–or that this would be the right forum–to make too much in the way of suggestions to you in this regard. I will say that the purpose of the 3-count is to make sure that the children recognize the pattern of warning and then punishment. Given the pattern established, a 2-count my be a worthwhile experiment. You have one warning that the behavior is unacceptable. If it is not stopped, then the punishment. I’m hesitant to suggest it, because it introduces more ways to inadvertently carry the technique off-track or confuse the child.
My daughter is like me in that she resents punishment. It never worked to correct my behavior, it just made me angry. For that reason, we have had better results with “punishments” that remove something good than those that add something bad. For her, we instituted a modified token economy. She has a jar that is filled with 25 tokens at the beginning of every week. She can buy things that she wants with them. When we count one, we tell her how many tokens are at risk. When we reach three, they are removed from her jar. My wife came up with a reward that she absolutely loves. When she goes to the store, she will pick up small, inexpensive toys (like sticker books). She puts them into paper bags so that Daughter1 cannot tell what is in them. If she has 10 tokens she can buy one. If she goes a week without losing any tokens, she gets one automatically. Daughter1 absolutely loves to get a “grab bag”. Admittedly, we have not implemented the token economy as fully as we should, but those damn grab bags have proven to be a powerful influence on her behavior. We will have to make changes to it soon, because she has advanced to a place where she keeps track of how close she is to being down to 10 tokens. Catching these kinds of things and finding resolutions for them are part of the continuous monitoring that is required when using some of these kinds of techniques.
All that being said, based on your report, you are describing the exact kind of dilligence, discipline, and care that I wish was more common. If nothing else, your reluctance to medicate the child has given his brain time to grow without “meddling”. While I believe that there are approaches out there that might yield more success–and I do encourage you to seek them out if you can–I’m not nearly as bothered by your decision to medicate as I am by the process that is more common these days (diagnose a disorder, prescribe a pill). To be honest, it sounds like you are using a degree of observation and care that raises your decision well out of the range of “any of my fucking business”. Nonetheless, I think it might be interesting to try to contact Dr. Phelan, report your results, and see if he has some guidance in sound ways to adjust the techniques. I think you are likely to get suggestions that are far better than any I can offer.
While I feel that I have enough knowledge in this area to justifiably complain about a lot of what is going on in the field, I don’t pretend to be anywhere near as qualified as guys like Dr. Phelan who are doing the work and getting the results.
-VM
VM,
What you seem to be hallucinating is that there is any data, let alone convincing data, that DI is an effective stand alone treatment for ADD. None of your cites support such a claim. Other cognitive behavioral approaches have been tried with some success, but none match up to the efficacy of medication. Once again, that doesn’t mean that behavioral intervention isn’t occassionally effective alone. Structure. Structure . Structure. Drill on organizational skills, long range planning, etc. Front of the class. Small group instruction when possible. 1-2-3 is good for some, others need to move up to “The Explosive Child” (Greene), and all would benefit by understanding some dimensions of temperment and understanding tempermental fit (see books by Stanley Turecki, for example). Consistent parenting and deciding what fights are worth having. All kids with ADD are different just like all kids are different. No magic bullets. But often meds need to part of the mix.
Sorry, but your undergraduate psych major doesn’t seem to have left you too well informed. I’d be happy to join you in thread about educational techniques in general and how the pendulum swings from holistic approaches to drilling ones like DI and back again with some regularity, for the underprivliged, for autistic children, and to discuss the educational accommodations that are useful adjuncts in helping kid with ADD. But such are not the point of this thread or relevant to your bluster.
My daughter is not autistic. I fully expect that, sometime in the next few years, someone will try to convince me that she has ADD or ADHD, although we have put a fair amount of effort into “correcting” most of the associated behaviors prior to inflicting her on the local schools, so we may have averted some of these, um, discussions.
The reason why I mentioned my experience with an autistic child was to demonstrate that proper use of behavioral techniques can yield amazing results, sometimes even in the presence of severe organic dysfunction. While the progression does not quite work out as a syllogism, the logic (and my experience, which so many people think to be worthless) is that they can do even more in the case of children where the case for brain dysfunction is much less clear.
Again, it is fair to say that a lot of the debate hinges on where you choose to draw the line between “dysfunctional” and “different”. I am the type of person who tends to celebrate difference. At the same time, I think that it would be cruel to not help a child whose differences are leading to suffering. If the only two choices were doing nothing and Ritalin, I would favor Ritalin over needless suffering.
I have made an example of my lack of aptitude for music. If you were teaching a piano class, and I was a student, chances are you could embark on a course of instruction where many of the students would progress but I would be left behind. One of the arguments of the Direct Instruction folks is that, if you were using better techniques, you could teach in a way that ALL the students, even inept Smartass, would progress. This particular claim is a little more difficult to support, but they have achieved some damn impressive results so far, some of which you can check via the links in my earlier post.
With regard to “disorders” like ADHD, I am far less interested in debating whether they are disorders than the mindset of “diagnose, medicate”.
-VM
One final thought: Recently, after years and years of treating ulcers with symptom-focused medications like Tagamet, doctors around the world came to the realization that a whole damn lot of the ulcers they were treating were caused by a type of bacteria and could be completely resolved using antibiotics. The doctor who discovered this was treated like a nutjob and his results were ignored for over a decade.
Does this mean that things that I have been telling you about Direct Instruction are true? Of course not. But what it does mean is that sometimes hordes of people with advanced educations get something in their chosen field completely fucking wrong. Everyone here has every right to disagree with me, but you should at least consider the possiblity that I am right or that, if I am wrong, it does not mean that I am crazy or that I wish harm on children or their parents. Just scanning over the posts in this thread, it is quite obvious that most of the posters are far less interested in considering any of my statements and are far more interested in finding weakness in my arguments to attack. It doesn’t matter who is right; it matters who wins.
I submit that, if you were as interested in the topic as your emotional responses suggest, you would me more interested in learning more than in trying to rip me to shreds. Given my time out of the field, I might present an argument incorrectly or overlook a forgotten detail. In such a case, the debate is lost, and all of you may have missed an opportunity to learn about something that could improve your lives. If I am not a Ph.D. in the field and am not sitting in front of every study conducted in the last decade, there is no way that a single claim I have made is true. And everyone knows that every anecdotal piece of evidence is always wrong. And while you imagine me as some kind of loony mystic, there are Ph.D.'s running around inventing new kinds of brain phlogiston every day.
Hopefully, I have made some people aware of options that they may not have known they had. In terms of winning a debate about what will work and what won’t, I will happily concede: Everyone of you here is right. I don’t have any fucking clue what I am talking about. You win. Spread the wonders of Ritalin far and wide; maybe we can achieve the 50% penetration that Judge Judy suspects.
I have nothing at stake here. I will continue to raise my children according to what I believe regardless of whether you believe any of my statements. But banging my head against this particular wall of competitiveness just isn’t worth it to me. I’d rather lay down in an antbed.
With that, I bid you all good night and good fortune.
-VM
Re the cites of your previous post
Jeff Lindsay believes in Inteligent Design.
“In fact, the evidence for design, when honestly considered, is so powerful that it can even lead “devout atheists” to conclude that there must be some kind of intelligent being who worked to make life possible”
I will not listen to an ID adherent on any matter of science.
After wading through the second cite, I saw nothing mentioning ADD. This cite is irrelevant to this thread.
Of the DI homepage, cites only one article is relevant. That study included only ten students, not all of whom had ADD… If you want to convince anybody that DI is an effective treatment for ADHD, you’re going to need a much larger sample size.
This thread is not about juvenile delinquency. This thread is not about kids from poor neighborhoods. Those cites are irrelevant.
The next cite has no information on using DI to treat ADHD. It is irrelevant.
As Guinastasia said, the Washington Times is owned by the Unification Church of Sun Yung Moon. It is not a reliable source.
The 'what is DI?" article does not address using DI to treat ADHD. It is irrelevant.
The word doc you didn’t bother to read (In all honesty, neither did I. I just read the table of contents) does not address ADD. It is irrelevant.
Moving along to the next post
Then provide either cites or a convincing argument for that case. So far, you seem to be saying ‘If it works on autism, it must work on ADHD’.
Which would imply that we are not. Thanks.
But at present, you seem to favor needless suffering over ritalin. The token economy sounds familiar. 1-2-3 is very familiar. Most of the LD teachers I had used both. They didn’t work without my pills. It wasn’t a matter of timeframe. Without structure and pills, I didn’t function.
Any and all claims made by DI are irrelevant unless they relate to ADHD. As Dseid said, this thread is about ADD not educational models.
I’m familiar with H. Pylori. (That would be the bacteria, not the scientist.) BTW Can anybody remember the name for the ‘They mocked Galileo too’ fallacy?
You haven’t shown me any proof that DI is effective in treating ADHD.
I never said that it did.
Actually, you convinced me rather quickly that you were wrong. (I base this on my lifetime of experience, every ADHD book or study I’ve read, and information I’ve learned in previous ADD threads). Being convinced that I’m right and you’re wrong, and that your position will ( very much unintentionally) cause suffering to children with ADD if followed, it becomes my moral duty to convince the audience that I am right.
If this were a thread about educational reform, than DI would certainly be worth looking at. This is a thread about ADD. I have looked at your claims that DI is an effective stand alone treatment for ADD and found them to be wholly unsupported.
It isn’t just one poor argument or detail. You presented no good argument, and only one ambiguous cite with far too small a sample size. This isn’t a case of us nitpicking your argument. You’ve failed to prove anything.
I never said either of those things. I don’t see where any other poster did either. You are simply putting words in our mouths.
Are you saying that neurochemistry is a crock in general? Or accusing us of blind allegiance to PhDs? Either way, you’re wrong.
I support things like token economies, standardized warnings and punishments, etc for kids with ADD. But, I maintain that in most cases they are not effective without medication. Conversely, in most cases simply medicating an ADD kid is not effective without things like token economies and standardized warnings and punishments.
I agree with this without the need for a cite.
Nice strawman. I don’t want to stuff ritalin down every child’s throat. But, I want to make sure that every kid who needs it, does get it. I want to make sure that parents can be allowed to do what is best for their ADD kids without being told that their dupes of the pharmaceutical companies or having to hear bullshit about how giving their child medication is a cop out, or a sign that their poor parents, or that they aren’t patient enough, and especially no bullshit about how they medicate their child to make themselves more comfortable.
I do. What are the lurkers doing? Who are they? Who will read this when the posting is done and the thread is archived? I’m sure that some of those people will be parents, looking for advice. I don’t expect them to bow to my everyword and build a shrine to my posts. But, some of them will have heard the same anti-medication arguments you’ve made. They’ll feel guilty and wonder if they’re true. If I can show them that they don’t need to be guilty, and ritalin isn’t evil then maybe I’ll have helped a child get the help they need-not just so they can learn, but so they can think, so they can play, so they can live, so that they can do the things they want to do.
Again, maybe I can help one child. That’s why I’m so competitive in this thread.
Just to underline my point from above. Tantrum behaviors may very well be “associated” with ADHD, but they are not symptoms of ADHD. Reducing the frequency of tantrums would be a good thing for parents, but would not alter the symptoms of ADHD.
Also, autism and ADHD are utterly and entirely separate things altogether. Discrete trial training is probably the best intervention for autism. It is not a treatment for ADHD.
You have stated the italicized idea several times, but have yet to provide any citation for it. I would like to see at least one or two. In psychology as with other sciences, the burden of proof lies with the person presenting the hypothesis, rather than the rest of the world having to disprove it. You have also presented the hypothesis that drugs are prescribed willy-nilly to any child who displays only a few of ADHD/Aspergers syndrome behaviors, yet all you have given us is anecdotes and personal interpretations of years-old undergrad psych classes. Again, I’d like to see an epidemiological cite for your assertions.
Vlad/Igor
I’ve been spending some time trying to find some better cites for you guys, watching Oklahoma support my belief that Auburn should have been number two (and I’m a Bama fan, fer chrissakes), and recover from the embarrassment of having linked to an Intelligent Design advocate. In my defense, my focus in that search was to make sure that you guys know that Direct Instruction refers to a specific approach to teaching and to cut down on the general tone that I am just making stuff up for fun. At this moment, I’ve got a pile of pages open and have been vetting them specifically for ties between Direct Instruction and ADHD. Unfortunately, I probably won’t be able to start making them postable until tomorrow night.
One of the things that hampers me is the degree to which I have to rely on my memory for this stuff. Not too long after graduation, I loaned all of my materials and notes in this area to a teacher I knew and never received any of them back.
I’m doing this in the spirit of providing a some information for anyone who wants to give some more thought to the issue. In terms of trying to prove it to everyone’s satisfaction or win debate points, I am satisfied with my earlier concession. As far as I’m concerned, any parent who might make decisions for their child based on who wins or loses here is missing the point.
There is a part of me that is still a little resentful of health care professionals claiming that it is my responsibility to educate them in their own field. If we were debating Supply Chain Management techniques and someone starting talking about the use of techniques I had never heard of, I would immediately be on the hunt to find out what they are talking about before I started hunting for ways to out-argue them. In my unregulated field, if there is a solution technique that I don’t know about, it puts me at a competitive disadvantage. I still think that there is more of a focus on winning the game and “being right” here than there is on comparing ideas and lessening ignorance.
That said, I have been pondering a little about how this debate has followed in the Straight Dope tradition of starting with ideas and devolving to an exchange of barbs. I am willing to accept my share of the blame, but I also note that there is plenty to go around.
Just to be clear, I will probably not be able find the kind of cites that are going to prove anything to those who have entrenched positions. I think that some of the stuff that I have gathered will show that the things I am saying are not completely baseless and will be enough of a start that anyone who wants (or needs) to learn more will have a jumping off point. Diagnosis and treatment of ADHD is closely tied with education, as is Direct Instruction. I am not the only person who believes that education in this country is dominated more by politics than by any sort of dedication to excellence. Abandoned on so many fronts, parents are having to fight for improvements, such as charter schools, pretty much alone. In terms of making the benefits of psychological research (in contrast with pharmaceutical research) more widely available, it appears that parents will probably be fighting alone again. The cites I am researching are for the benefit of those that are motivated to join in the fight for better solutions for our children in general. If the only thing at stake here was winning the debate, I would not bother.
I’ll make a few comments on new posts, but I want start in the direction of less bickering and more meaningful discussion, so I’m going to be very selective. These you get now. Hopefully, I’ll have some better cites and sources for you tomorrow. In the meantime, I beg your indulgence. The intersection of ADHD and Direct Instruction is a little tedious to try to target, and since I am so long away from this field, I don’t have much that is handily available to me outside of the good ole Internet, and I’ve already provided new evidence that, when reaching into this particular bucket, it is as easy to pull out a turd as a pearl.
The expected “process” for research is to start small and, if the results are promising, work your way up as more people take notice and resources are made available. Because Direct Instruction challenges a lot of the Education lobby’s favorite political stances, it has met continuous stiff resistance throughout its existence, so the process has been far from optimal. I know that this doesn’t in any way invalidate your complaint; there just isn’t anything I can do about it.
From my seat, it does appear this way. I have known quite a few people who were openly distrustful of difference and perfectly proud of it. The fact you are insulted by my implication is at least encouraging.
Thanks for sharing. However, I don’t feel any obligation to assign any more validity to your reports of your personal experiences than you do to mine.
ADHD is considered a learning disability and the diagnosis and treatment of it is closely tied with educational success. In fact, one of the key diagnostic criteria is the degree to which the “disability” affects academic performance. Without failure to succeed, there is not valid evidence of disability. To the extent that better instructional techniques can ensure that those currently labeled as ADHD are not left behind, the case for claiming disability is lessened. In my earlier post, I linked to and highlighted a relevant quote that showed that Direct Instruction techniques were able to bring the bottom group “up” into the group of non-disadvantaged students. Nonetheless, I am working on some cites that don’t require you to agree with this entire chain of reasoning.
This quote leads me to believe that we may not be as far apart as it has been seeming. Maybe the next few days will tell.
Another quote that highlights our similarities. I feel the same way.
No, I did not theorize about particular consequences. That was another poster going an extra step past what I had said. If I were going to postulate the type of danger that the drugs might pose, it would be more closely related to a dependence on the medication. ADHD kids have a difficult time learning some self-management skills. The medication, at least to some extent, substitutes for those unlearned skills. I acknowledge that you prefer to think of what I am calling “unlearned skills” as “incapacities”, but bear with me in my paradigm for a moment. I suspect that these skills are similar to language skills in that they are harder to develop as people get older. Children tend to pick up second languages easily. Adults do not. My suspicion is supported (but not proven) by the many reports that early intervention in ADHD is key. My specific concern is that children are allowed to rely on the medicine during the time when they should be learning the skills, and that with each passing year their likelihood of ever learning the skills will decrease. This same logic is the reason why I am less resistant to the idea of medication in adolescents and, particularly, adults. Even if I am right about the skills being teachable, it may well be too late to teach them if it is not done by adulthood.
-VM
OK, here is my specific concern with your reasoning: what if there is indeed a physiological or chemical component to this disorder? (And there is evidence to support this in neuro-transmitter and -receptor research.) What if this component is being boosted by drugs such as Ritalin, thereby making the brain itself function correctly, which in turn would lead to a child whose actual capacity for training is increased?
People have made the comparison to diabetes, but let’s look at epilepsy as a better comparison - we now know, beyond argument, that an epileptic child has an electrical malfunction in the brain itself - the physical organ is not functioning the way it is supposed to. One of the things we’ve learned about epilepsy is that barbiturates can be used to control the seizures (I’m not fully up-to-date on epilepsy, so I’m not certain if newer anti-convulsant drugs are barbiturates, but as recently as the 1990s I know epileptic children who were on Phenobarbital.) Without the constant threat of an imminent seizure, children with epilepsy could focus on whatever task was before them.
Now back to ADD - if the organ (the brain) is physically malfunctioning, all the patient, thoughtful, consistent instruction in the world is not going to make it function properly.
Again, I have only personal experience and I’m pretty certain my brain doesn’t work like “normal” brains. And I can only imagine (and that’s the sad truth) what my life would have been like if there had been a better knowledge of ADD when I was a child. For the record, I was sent to psychiatrists, psychologists, medical doctors, social workers and therapists for years when I was a child. My parents were told over and over again that I was just stubborn, and that if they kept at me, I would come around. So I lived for nearly 30 years not understanding why, no matter how hard I tried, no matter how religiously I followed their rules, I could never make it work.
It’s really very simple VM. GD is about supporting a POV with evidence and logic. Evidence is graded- controlled studies are better than case reports, for example. You came in with some opnions but stating them as fact because of your authority (an undergraduate degree shared by many working at McDs) and in the process dissed a lot of people with substantial authority in real life experience living with the condition. And arrogantly claiming that you are teaching professionals because we are telling you what the evidence actually shows … and providing the evidence. You failed to suppport your claims in any meaningful way other than as opinion bits. Sorry, your reception is unsurprising.
I will try to help the rephrasing of the debate:
I am nearsighted. Can’t read a blackboard more than a few yards away. Should we “celebrate my difference”? Should treatment of me be limited to teaching me to listen better so I do not need to read the board? Or getting teachers to write real large? Or should I get glasses?
The analogy is not perfect, but it is instructive to understand where it falls off.
Firsrt off is that vision can be easily measured. Sure it is a disability that blends away from normal and reaches an arbitray point called dysfunction, but you can easily measure it. Attention is harder to measure so it is inherently squishier.
Secondly is the discomfort you have with meds as opposed to glasses. Glasses you presume can do no harm, but meds! Clearly you are unassured by decades of experience without harm found. The concept bothers you. And certainly I do not totally disagree - any intervention has potential harm and meds are more than glasses, the younger the patient the more the theoretical risk and the less solid the experience for safety. The benefit should be substantial and extremely substantial for a younger patient. But despite your claims, few other methods are anywhere near as effective. Getting teachers to do the equivilent of writing real large just hasn’t worked too well for most. One can argue how substantial a benefit is needed to justify meds and if we meet that threshold all the time. One can wish for better studies of long term benefit. But stimulant meds do work for ADD for at least the immediately measurable effects and are fairly safe from school age on in long term use; on this the evidence is quite good.
And third is our discomfort in thinking of behavior as a manifstation of physical processes. As reflected in other threads, the predestination vs free will issues; the concern that explanation equals exculpation. Here too it differs from glasses. And here we just need to grow up.
One more issue. Do we overpathologize? Is our world overly broadly defining dysfunction and are we finding too many nails because we have effective and well advertised hammers? I do not know but I am curious for the thoughts of others.
What an arrogant and asinine comment. I’ve been spending time here trying to disabuse others of the misinformation you have been providing. I would be sadly misinformed if I were taking my education from you. Being asked to justify an assertion is not “bickering,” nor is it unreasonable in a discussion.
In other words, you’ve found that you cannot really support what you were saying. Don’t blame others. Take responsibility for yourself. I see a lot of discussion of references, but no references.
This is incorrect. ADHD is part of the Attention Deficit and Disruptive Behavior Disorders cluster. (I argue for the disentangling of Oppositional Defiant Disorder and Conduct Disorder from ADHD, because I think that the link from ADHD to CD has been overstated, but that is another discussion).
Learning Disorders are distinct, both nosologically and functionally, from ADHD. Furthermore, ADHD often results in poor academic performance, but diagnostically, it does not rely on academic performance. That is to say, a child may have ADHD and not necessarily do poorly in school.
A key criterion is impairment in a core domain of functioning, but this might be academics, social environments or occupational settings.
It seems that you have an understanding of ADHD that conflates it with autism, tantrum behaviors, and now learning disorders. I can understand where your concerns might come from, given this misperception.
All this talk of “DI” being used to treat ADD is making me think of Drill Instructors.
I suppose that’s been tried, but geez, talk about old school…
Which really in a fundamental way brings us back to the definitional issues I inquired about in my OP. Speaking only for myself I think we do, and that once a new paradigm of dysfunction is established, a lot of behaviors that were once just part of the range of acceptable of human diversity get stigmatized and channeled into that corral of “dysfunction”, and once there are branded with the constellation identifier of choice. When the rise in pathologized dysfunctional attention behaviors becomes a virtual “epidemic”, I think we really need to ask ourselves are there really that many people who are inherently mentally dysfunctional, or are we running around with a paradigmatic hammer looking for behavioral nails.
This is somewhat of a tangent, but I just wanted to clarify something that I posted previously. I had indicated that Smartass’s description of Direct Instruction sounded like a form of discrete trial training, which is the most well-supported treatment for autism.
See this website for a brief description: http://www.asatonline.org/about_autism/autism_info06.html
After looking into Direct Instruction a bit more closely, I need to say that the two (Discrete Trial Training and Direct Instruction) are distinct. Although they appear to share similarities, Direct Instruction appears to be an educational program that is suggested for a diverse population of children, and has in some instances been used with children with autism to address academic issues. Discrete trial training is specifically a behavioral mental health intervention for children with autism or other developmental disorders to help reduce symptomatology and improve self-care, communication and social interaction skills.
The type of intervention that Smartass was engaged in during his seminar experience is consistent with discrete trial training.
It certainly is possible, since we are attempting to identify instances of these disorders by a subset within a proscribed constellation of behaviors, that a child would be misidentified if a person making a diagnosis did not carefully ensure that the criteria were met. Careful practice is the best defense here, but isn’t always the reality, to be sure.
It is also possible that the identified constellation of behaviors is erroneous, such that a person might meet the criteria but not actually have the disorder. As we progress, in my opinion, this becomes less likely, but obviously cannot be ruled out. The criteria we have now hold up fairly well under scrutiny, but are not perfect. We continue to ask questions like “Would the inclusion of “frequently daydreams” improve the reliability and validity of the diagnosis?” and “What are the differences between inattention and hyperactivity-impulsivity, in terms of comorbid conditions?” If we can amass enough empirical evidence, the referent behaviors might be altered to improve the construct.
However, I do not believe that a child who frequently loses his school assignments, but shows no other symptoms of ADHD, will be caught up in a frenzied net of pathologizing by professionals. Come to think of it, the criteria are already “pathologized” anyway, in the sense that we don’t typically think it is a good thing to regularly lose or misplace your belongings, jump out of your seat in class, or interrupt others. The question is how can we reduce the false positives and false negatives in the identification of who has ADHD.
One more item VM,
Are you already aware of how Individualized Educational Plans (IEPs) work?
Parents can request that their kids who are not up to grade level be tested by the school system and determine if they qualify for an individualized plan. The diagnosis of ADD with nonperformance to grade level qualifies students for an IEP if requested. So do learning disabilities (which may occur in conjuction with ADD). The educational professionals then collaborate with the parents on a plan, which may include one on one help, various kinds of homework log sign offs, resource room work, etc. They do not advise a single approach (like DI, for example) for all children. Rather kids have a full educational battery and specific recommendations are made. Now not all schools are perfect at implementing this and sometimes parents need to be very vocal advocates for services, but the point is that the choice is not per se meds or educational intervention. Yes, schools may sometimes suggest an evaluation for ADD, knowing that a treated child will do better with less intesity of intervention on their part, but parents deciding with their child’s doctor have the final say on meds.
I think there is a link, but I haven’t seen it discussed so far. I am beginning to believe that autism, Aspergers and ADHD have a root cause that manifests itself as a sensory integration problem, depending on the severity. I don’t think this is the sole cause of any of the disorders, but at least one common one that might reflect an underlying cause (see my post #3 re: Dr. Casanova’s work). In reference to the OP, maybe this could be called the Sensory Integrative Disorder, which would refer to several neurological disorders.
A quick Medline search through Ovid pulls up the following:
Developmental Medicine & Child Neurology. 46(7):444-7, 2004 Jul
“101 children with PDD were reviewed. Ninety-one children had a diagnosis of Asperger syndrome, nine had a PDD not otherwise specified, and one had ‘high-functioning’ autism. 95% had attentional problems, 75% had motor difficulties, 86% had problems with regulation of activity level, and 50% had impulsiveness. About three-quarters had symptoms compatible with mild or severe attention-deficit-hyperactivity disorder (ADHD). …”
American Journal of Occupational Therapy. 58(3):294-302, 2004 May-Jun
Responses of preschool children with and without ADHD to sensory events in daily life.
“Based on the measure of mothers’ perceptions, children with ADHD demonstrated statistically significant differences from children without ADHD in their sensory responsiveness…The findings of the present study suggest that young children with ADHD may be at increased risk of deficits in various sensory processing abilities, over and above the core symptoms of ADHD.” IOW Sensory processing may be part of ADHD, but this study suggests that it is not consistantly present.
Journal of Autism & Developmental Disorders. 33(6):631-42, 2003 Dec
Parent reports of sensory symptoms in toddlers with autism and those with other developmental disorders.
“The Short Sensory Profile was used to assess parental report of sensory reactivity across four groups of young children (n = 102). Groups were autism (n = 26), fragile X syndrome (n = 20), developmental disabilities of mixed etiology (n = 32), and typically developing children (n = 24)…Both children with fragile X syndrome and children with autism had significantly more sensory symptoms overall than the two comparison groups”
I need to look into it further through the psych literature, but this is my own impression.
Working in Pathology and laboratory medicine for 10 years (the last 3.5 in research), my gut reaction is to find some sort of qualitative or quantitative test involving some body fluid or diagnostic imaging to take the guess work out of diagnosis. Behavioral indices would still be useful as a screen and act as a gateway for lab/d.i. confirmation.
Vlad/Igor