View Full Version : the adhd debate


daveddd
11-22-13, 07:15 PM
like most wild partying adults on a friday night i was cruising pub med, seeing what was new on the adhd front

liked this, thought id share

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3814004/

Amtram
11-22-13, 09:11 PM
This is a critique of another article. A little searching led me to a full-text pdf of the original here (http://www.gck.nu/admin/files/sd_area/Jim%20Wilson%20ADHD%202012.pdf). It's 21 pages long, and only 5 pages in, I can see why it needed a critique from other authors in the same journal that originally published it.

It essentially says that researchers into the biological origins of ADHD should stop being so prejudiced and saying there's no psychological causation of ADHD. Which is a combination of several strawmen. He says their prejudices lead them to improperly treat people with ADHD.

He then goes on to say that a proper psychotherapist, like him, needs to have prejudices in order to effectively treat patients, and he encourages an open dialogue in which the psychiatrists and scientists shut up and listen while he tells them point by point why they're wrong.

Hoo-boy!

The article you linked is a great response that urges the kind of approach to diagnosis and treatment that most good researchers and clinicians of all kinds aim for in the first place, where you attribute causation of a specific aspect of a patient's condition to the area that has the most evidence supporting it, whether that be physical or psychological, and update your understanding as new evidence arrives.

It advocates psychiatrists treating the medical aspect, and psychologists and other therapists treating the psychological side, and practicing their own specialty appropriately without denigrating the worth of the other practitioner's specialty.

It says that it's important to follow the evidence and change your personal perceptions if they conflict with the evidence so that you are focused on the best outcome for the patient. So bravo to them.

daveddd
11-22-13, 09:20 PM
yes i liked it for the reasons you mentioned

i thought it gave a good perspective of open mindedness


reading the critique of the original article gave me no desire to read the original

Dizfriz
11-22-13, 09:25 PM
I really like the conclusion. It fits in with my thinking well.


Conclusion (Paragraphed for ease of reading)

It is good to have dialogue and challenge current thinking but it is an academic luxury, in our view, to challenge without providing alternative empirically testable proposals.

Where conceptualizations, personal beliefs and instinct-led interventions are offered to help families and children we need to be assured that such recommendations are evidence-based, pragmatic and affordable before services and practitioners might be expected to flexibly adapt to changes in evidence irrespective of whether the evidence is incompatible with our personal beliefs or professional and practice preferences. Dizfriz

daveddd
11-22-13, 09:37 PM
i would say that makes sense


i just wonder why since its a known fact that genetics interact with environment, why that interaction isnt talked about more

Amtram
11-22-13, 11:06 PM
Because, first of all, specialization. A molecular biologist or a geneticist or a developmental psychologist need to look for specific associations that are within their specialties in order to come up with valid evidence. It's not that they deny the importance of whatever thing that isn't within their field, it's that they're not studying things that aren't within their field. A geneticist is going to talk about genetics because he studies genetics. Just because he studies genetics and publishes findings on his genetic research doesn't mean that he thinks nothing else in the world could even remotely have any impact on anything except for genetics.

There are scientists who study ONLY auditory processing in the brain. Nobody accuses them of thinking that vision isn't important, or that people don't appreciate music, or anything like that. There are scientists who study only specific bacteria, and we never hear about how they deny that diseases could be caused by bacteria they're not studying, or that they're virus deniers. It's really the same thing, just with more internet and media hype.

Second, you can't study how one thing affects another thing unless you know how that one thing works. And those things need to be very specific. So really, what you're looking at when it comes to something complex, is looking at how a piece of one thing affects a piece of another thing, and that takes huge amounts of time and effort.

We can take something that has a much more easily defined cause, like Post Traumatic Stress Syndrome, and examine how age at the time of the trauma affects outcome, or how type of trauma affects outcome, or even bring in the genetics aspect and group people who had the same trauma at the same age and see what the differences are between the ones who ended up with PTSD and the ones who came out relatively OK.

But no matter how much of that data is gathered, little, if any of it, can be then applied to any other condition besides PTSD. And if you do get some significant finding on the genetic level about susceptibility to PTSD, it says nothing about susceptibility to anything else. Results for one thing don't automatically translate over to something else.

Genetics and environment are both nearly infinitely complex, so you would have to do infinity times infinity experiments to discover all the possible interactions between genes and environment. (Maybe more, because then you'd have to do experiments for all gene pairs and individual environmental factors, and then individual genes and pairs of environmental factors, and so on. . .)

And this would never, ever, ever stop, because we evolve biologically and gene mutations arise randomly, and all the different possible social environments throughout the world are constantly changing. . .this kind of research would be a total waste.

So the specialization serves an important purpose - to isolate factors that occur in significant amount under certain conditions to see if they are worth researching, and then to find out specifically what those factors' relevance is under those conditions.

dvdnvwls
11-23-13, 12:48 AM
Science is limited to what is study-able for a very good reason: knowledge itself is limited to what is study-able. When someone proposes that an un-study-able thing be believed, the reasoning behind his proposal can always be reduced to "because I said so", and that is never a sufficient basis for belief.

That whole argument that I just made, is only for the benefit of those who actually want to propose things that can't be studied. For the rest of us, a simpler explanation suffices: Guessing is not good enough. In fact, "guessing is not good enough" expresses the same idea as my entire first paragraph.

Most of the field of "critical thinking" is simply a reminder to always take notice of anyone's inappropriate use of guessing (including one's own), and never to let guessing pass for knowledge.

daveddd
11-23-13, 08:35 AM
all good responds, thanks everyone

i guess my fear is that i hope we arent making something into something far, far more complex than it has to be

and that we dont miss something thats right under our noses

daveddd
11-23-13, 08:38 AM
and i also forgot , where it mentions psycosocial stress can change biology , i think ginnebean hit something right on the nose in another thread with that

sarek
11-23-13, 04:18 PM
Mod reminder: We've already had to remove off topic posts from this thread. Please remember that we are in the scientific discussion section, not the open section.

Guidelines will be enforced, up to and including warnings and infractions.

daveddd
11-23-13, 04:29 PM
great thread amtram

Amtram
11-23-13, 07:08 PM
But again, the problem is discovering the "mechanism" first. And while the mechanism might be consistent, the results might not be exactly the same for each individual. I mean, why do we have so many different kinds of painkillers, and so many different ways of delivering them, sometimes even different ways of administering the same chemical? It's because of biological diversity, which is then further complicated by the nature of the thing that's causing the pain.

The more specific you get with the details you're studying, the more likely you are to find out something useful. You can't get much more specific when it comes to biology than the genes that create the cells of which a living thing is composed.

Still, though, we're not going to find "a genetic cause for ADHD." We might find a genetic cause for a chemical imbalance in the hippocampus or for a missing axon in the right orbitofrontal cortex. We might find a gene that's strongly associated with short-term memory impairment, or even impulsivity.

That's the mechanism. That has to be figured out first before we can start testing the mechanism to find out what makes it work. This is the kind of research that's being encouraged now, and it's going to result in a completely new approach to diagnosis and treatment - someday. Because every time a mechanism is discovered, that's phenomenal, but it also means that it's one more thing that has to be studied from multiple angles.

In the short time that we've been researching epigenetics, not only have several studies been overturned when third or fourth generations don't display the expected result, but we've gone from "methylation changes gene expression" to "methylation and acetylation change gene expression" to "methylation, acetylation, phosphorylation, and at least five other types of histone modification we haven't figured out yet change gene expression."

Imagine how little we would know if we'd stopped the first time we altered gene expression in mice and rats and said, "OK, that wraps that up. Now we know everything!"

daveddd
11-23-13, 07:19 PM
yea i believe the "mechanism" leads to different results in different people

although with fairly common patterns of results tending to emerge

Amtram
11-23-13, 07:24 PM
Yes, that's why they are mechanisms, or models, or. . .evidence. If something isn't repeatable or replicable, it's not terribly valuable as information.

daveddd
11-23-13, 07:29 PM
more clearly put, this is how i see it
http://books.google.com/books?id=Tna-9d_ykPIC&pg=PA63&dq=theodore+millon+biosocial+learning&hl=en&sa=X&ei=xzmRUpcjiceqAZ-xgLgI&ved=0CEAQ6AEwAw#v=onepage&q=theodore%20millon%20biosocial%20learning&f=false

is that like what you are sayinh?

daveddd
11-23-13, 10:11 PM
im just trying to get a better view of your guys perspective

also show if i mention something else i know genetics is involved, im not trying to make it a one or the other

a lot of the stuff im unraveling with my doctor

he is strictly the pill prescribing type, but likes to talk about psychology

in pub med he had 2 pages of studies, all meds for a well known cleveland medical facility

yet he is the one pushing mindfulness on me, like in the article he is accepting something that isnt his specialty

its encouraging , good doctor

janiew
11-24-13, 02:13 AM
Okay, I will share. I've just finished a year of psychotherapy with a psychologist who does psychoanalysis work. Halfway through, I felt it wasn't helping in my problem areas though I was doing some difficult work on myself. That things were getting worse. So I went to see a psychiatrist who diagnosed me with ADHD - which was a new concept to me - and anxiety / OCD - which I knew was an issue.

ADHD was new to me and I questioned the diagnosis. But I learned more about it and knew from experience that I focused better on tramadol (which has SNRI properties). And I knew one of the most productive times I've had in my life was when I quit smoking with Wellbutrin - though at higher dosages it made my anxiety / OCD worse.

My psychologist released me this week from weekly therapy and we will meet on an as needed basis going forward. He said I appear to be doing much better with meds and here's to better living through pharmaceuticals. He said the psychotherapy paradigm can be judgmental and some issues in life/mind are indeed physical and should be treated as such.

I responded that I agreed with him wholeheartedly and went on to say it's all related - mind, body, spirit - and that untreated issues in any realm can affect the other areas.

If one has ADHD, meds AND therapy will help bring things into focus. At least from my experience.

Amtram
11-24-13, 01:06 PM
My best psychologist ever insisted that I see a psychiatrist for pharmaceutical intervention because I would not be able to overcome any of my psychological hurdles without it. One of my psychiatrist's first questions was whether or not I was also undergoing therapy.

Specialization doesn't limit options so much as it improves the effectiveness of treatment with the deeper knowledge that specialization brings.

When my tumor was diagnosed, my neurosurgeon consulted several other specialists in oncology, bone disease, and so on, to make certain he was informed of the various possible causes of my tumor, before he opened up my head. He's one of the best neurosurgeons in the area, but he took advantage of the more extensive knowledge of other doctors in different fields to make sure I was getting the best treatment. That's exactly the kind of thing the original article is advocating.

SB_UK
11-25-13, 09:28 AM
If one has ADHD, meds AND therapy will help bring things into focus. At least from my experience.


Personally - my solution to ADHD is to place oneself in a zero (di)stress (mostly work related) environment.

Meds don't do anything for me.
I'm not too sure what therapy means.