View Full Version : Teleconference


mctavish23
03-26-05, 01:44 AM
I had the pleasure of listening in on 2 teleconferences on ADHD put on by United Behavioral Health, a managed care company.Yesterday was on ADHD in Adults and today was ADHD in kids.The presenter was Russ Barkley, who did an excellent job.I managed to take good notes on both.I even got to ask a question over the phone today....lol.

I'll be glad to post some of those notes later if you'd like.

Ian
03-26-05, 03:32 AM
I'd like very much to read your reflections. Thanks for the offer.
Cheers!

RhapsodyInBlue
03-26-05, 03:56 AM
Mctavish, I would be really interested in what you would care to share. Thank you ;)

Wheezie
03-26-05, 10:06 AM
I'd like that muchly, McTavish! :cool: , W.

Andrew
03-26-05, 11:53 AM
As always, Mct...your insights and observations are welcomed :)

mctavish23
04-06-05, 10:26 PM
Both were excellent.He didn't present anything "new" to me, but it was good to see that his theory has advanced on there being a select subtype within the Inattentive type that he calls "a qualitatively different disorder" i.e., Sluggish Cognitive Tempo.

Thats just an idea for a name and not anything "formal." You wont find it in a book; not yet anyway.He also went into detail on the need for age referencing adult ADHD symptoms. What he means by that is that as you get older the symptoms need to be worded differently and there can be fewer of them than required with kids.

I'll look more at my notes when I get a chance, but overall it was great.

The one on kids was also fun. He presented much of the same data, however, there were some differences in terms of the need for behavior management techniques to be immediate and applied at the point of impact (the setting in which they occurred). He also spent time going over the impact of ADHD on the executive functions and how potentially devastating it can be.

Probably the "best" thing for me, was that he began both of those by documenting how ADHD is a "real disorder." In doing so, he used Jerome Wakefield's definition again.
It concerns me though that there are still people who don't know that or who haven't come to terms with it.

Ancient Music
04-06-05, 10:40 PM
Ill be looking for your further posts with great interest.

Ian
04-07-05, 12:01 AM
I did a search for Jerome Wakefield's definition but came up with only references to it. Does anyone know some place I might read the source documentation?

There was no reference to it at www.wikipedia.org either. I've made some minor contributions about ADHD there but it might be an idea to begin to have some input there on a more ambitious level.

I'm looking forward as usual to what you have to offer mctavish23.
Cheers! Ian.

mctavish23
04-07-05, 08:30 AM
Yes. I have the International Consensus 2002 article at the office, It has the original reference in it.I'll be glad to post it when I get a chance this am.

mctavish23
04-07-05, 05:53 PM
Here it is.Sorry it took me so long.Very busy day.:)

Wakefield,J.C.(1999).Evolutionary versus prototype analyses of the concept of a disorder.Journal of Abnormal Psychology,108, 374-399.

Ian
04-07-05, 10:11 PM
Thanks. I'll have to check the library. That's not a long time by the by. I'd have waited patiently for much longer. :*)
Cheers! Ian.

Drummergod35
04-12-05, 04:42 PM
Unlike medicine, there is no scientific basis for any of these “psychiatric disorders.” To indicate someone has a disorder means that there is an abnormality of some sort. Why then is there no physical proof whatsoever that these diseases, disorders, syndromes exist or a test which can differeciate ADD from say ADHD? We hear the term "chemical imbalance" yet there is no physical test that assertains the presence of any abnormality. Also, diagnoses by a pyschiatrist or psychologist is completely subjective. This has been admitted by the National Institute of Mental Health itself.
We hear that depression is a "disease" yet no pathogen exists and again, no physical proof.

(scratching head)

Tim

mctavish23
04-14-05, 12:49 AM
You obviously havent read some of the most recent posts concerning whether or not ADHD is a "real disorder." First of all there are virtually no lab tests for depression;including all forms of Bipolar, Schizophrenia ( in all its forms) , Tourettes Syndrome.Obssesive Compulsive Disorder,etc. The exact etiology of ADHD is unknown.No one is claiming to know that, at least not right now. As far as your statements about there being "no scientific basis"(/B) for these disorders, you are completely mistaken.

Here's the "proof" : These are ALL from unrestricted research grants published in (the cream of the crop) peer reviewed journals.

1) The neurobiological nature of ADHD.....THE PROOF YOU SAY DOESNT EXIST: was conclusively proven in the 1990 landmark glucose brainscan research study published in the New England Journal of Medicine....


Zametkin,A.J.,Nordahl,T.E.,Gross,M.,King,A.K.,Semp le,W.E.,Rumsey,J.,Hamburger,S.,& Cohen,R.M.(1990) Cerebral glucose metabolism in adults with hyperactivity of childhood onset. The New England Journal of Medicine,323,(30).1361-1366.

The "proof" is in the PET scans that showed that the harder a person with ADHD concentrated the "slower" their brain went vs the exact opposite for the non ADHD group. However, that was remedied when the ADHD subjects took stimulant medication.

THE definitive study proving the existence of ADHD as a "real" disorder;signed off on by over 80 of the world's leading scientists (with over 19 pages of references) is :

Consortium of international scientists:International Consensus Statement on ADHD, January 2002. (http://www.chadd.org). It can also be viewed at Russell Barkley's website.


You can turn to pages 22-24 of Sandra Rief's 2003 book.............The ADHD Book of Lists ....................to find the section (1-7) WHAT THE RESEARCH IS REVEALING ABOUT ADHD

Within that section is the reference for the Landmark MTA Study:

"There has been significant research with regards to treatments for ADHD and their relative effectiveness. The longest and most thorough study of the effects of ADHD interventions was the 1999 Multimodal Treatment Study of Children with ADHD (MTA) by the National Institute of Mental Health (NIMH).

MTA Cooperative Group" A 14-month Randomized Clinincal Trial of Treatment Strategies for AD/HD,"Archives of General Psychiatry,[I] 56:1073-1086;1999.

ADHD is primarily thought to be largely (80%) genetic/inherited.THE GENETIC LANDMARK FOR ADHD WAS FOUND IN 995. That study is as follows:


Cook,et.al.,(1995) Association of attention-deficit disorder and the dopamine transporter gene.American Journal of Human Genetics,56.993-998.

The US Surgeon General's Report on Mental Health: Chapter 3: Disorders of Infancy, Childhood & Adolescence has excellent background info supporting in great detail (with another 19 pages of scientific references).Here's a small segment on what I'm talking about:
" The exact etiology of ADHD is unknown,although neurotransmitter deficits,genetics and perinatal complications have been implicated." It goes on to say:

"Research to pinpoint abnormal genes is honing in on 2 genes;a dopamine receptor gene (DRD) gene on chromosome 11 and the dopamine -transporter gene (DAT1) on chromosome 5 (Cook,et.al.,1995:Smalley,et.al.;1998).

The latter reference is : Smalley,et.at.(1998) Evidence that the dopamine D4 receptor is a succeptibility gene in attention-deficit hyperactivity disorder,Molecular Psychiatry,3,427-430.

Recently (3/25/05), I participated in a teleconference on ADHD in children put on by United Behavioral Health (UBH: a managed care company). The presenter was Russell Barkley, PhD. He is largely viewed as the world's leading researcher on ADHD. During that presentation, he listed the following (evidenced based/research derived) data regarding the neurology of ADHD.

Decreased Cerebral Metabolism
(from Thomas Spencer, M.D.)

global and regional glucose metabolism by PET scan reduced in adults who have been hyper since childhood (thats Zametkin's research again).
Largest reductions in:
1) pre motor cortex
2) superior prefrontal cortex

Anterior Cingulate Dysfunction in ADHD, fMRI and the Counting Stroop.
Bush,et.al.,(1998).


Etiologies-Neurological

Smaller, less active,less developed brain
Regions found on MRI,fMRI and PET scans incluse the following areas of the brain:
1) Orbital-Prefrontal Cortex( primarily on the right side)

2) Basal Ganglia (mainly striatum and globus pallidus)

3) Cerebellum (central vermis area, right side) - there were some other posts about this particualr area of the brain being a key component of ADHD in a different thread I believe

Suspected Neurochemical Deficiency:

1) Dopamine dysregulation likely but not definitive....... the mere fact that stimulant
medication works at all to relieve symptoms of ADHD forms a solid basis
for helping to substantiate this (and the first medication study was done in 1937 in
Rhode Island)

2) Norepinephrine dysregulation probable

Etiologies- Genetic ( these data were all derived from research studies) The usual maker for statistical significance is 1.5 SD (standard deviation) 's from the mean, which equates to a %tile ranking of 93. In other words, the absolute lowest chance of these data being accurate is 93%.

1) Family aggregation of the disorder: 25-35% of siblings; 78-92% of idnetical twins;15-20% of mothers, and 25-30% of fathers; If the parent is ADHD, then theres a 20-54% chance of the offspring being ADHD (increases the odds 8fold)

2) Twin studies of Heritability 57-97%)

3) Shared environment 0-6% (not significant)

4) Unique environment (15-20% )


Molecular Genetics : Candidate genes on DRD4,DAT1,DBH-Taq1 (on chromosomes 3,5,and 11)

Candidate region: chromosome 26p13 region


Lastly, the answer to your questions about the difference between ADHD and ADD can be found in Barkley's ADHD and the Nature of Self-Control (1997).
It's also addressed in his 2002 book Taking Charge of ADHD (pages 137-138) and in You Mean Im Not Lazy,Stupid Or Crazy? by Kate Kelly & Peg Ramundo (Chapter 2).

As for depression, it is considered to be a Medical disorder on the basis of the chemical imbalance of the neurotransmitter serotonin. I don't know anyone who considers it to be a "disease".

There's no cure for the common cold but people know it exists. The Biogenic Amine Hypothesis was derived (via research) over 20 years ago. Here's what that says: "The concept that abnormalities in the physiology and metabolism of certain biogenic amines, particularly catecholamines[I](norepinephrine and dopamine ) and an indoleamine(serotonin) , are involved in the causes and courses of certain psychiatric illnesses."
That qoute was from an older issue of A Psychiatric Glossary of the AMerican Psychiatric Association, page 28. The new one is at the office.

The Biogenic Amine Hypothesis is what eventually led to the development of the class of antidepressants we now know as SSRI's (Select Serotonin Reuptake Inhibitor's:Zoloft, Prozaz,etc.).


This MORE than refutes your remarks. As of the summer of 2003 there were over 6k research articles,professional papers, chapters in book and books on ADHD.

If you go to the International Consensus 2002 journal article, you will also find on page 89:

"ADHD is recognized as a disorder/medical condition by the American Medical Association, the American Psychiatric Association, the American Psychological Association and the American Academy of Pediatrics."


THIS ISN'T AN EXACT SCIENCE .NO ONE EVER SAID IT WAS. But I can tell you that a T score of 70+% on the Conners Parent Rating Scale is one of the most accurate predictors of ADHD currently available (when used in concert with a thorough developemental and medical screening, behavioral observations and other screenings for executive functions; to name a few).


I could go on but I've made my point. I spent hours on this post and still had to cut it short. There's your scientific basis.

healthwiz
04-14-05, 01:04 AM
Hi McTavish

Phew you made your point! Someone hit your button for sure. Thanks for the detailed refutation. Feel better? :)

Now, I just wanted to say, thank you for letting us know about your teleconference, and please do let us know about your notes on it.

I also wanted to say HI! Long time we haven't chatted!

Take care

Jonathan

mctavish23
04-14-05, 01:19 AM
Hi, thanks.Nice to see you. The data from the reference to Thomas Spencer MD., all the way down to just before the Biogenic Aminne Hypothesis was taken from my notes from the teleconference. All of that info was included. I can get into some more detail later.

As for my post, that was nothing. Take care.

Gourmet
04-14-05, 03:39 AM
Hi Mctavish :)

I am so glad that drummergod posted his misinformation.

Thank you, as always, for your research, knowledge, and informative insight in regards to adhd.I appreciate having readily available the sources, dates, knowledge of, and references to the particular studies you posted in response. This is a benefit to us all :)

Yours,
Annie

mctavish23
04-14-05, 08:36 AM
I do want to say something about the issue of diagnosis. No one I know would ever contradict the fact that diagnosing ADHD is subjective; at least at this point in tiime.At the Door County Summer Institute, Dr Barkley speculated that there will eventually be a DNA test of some sort in the next 10-15years perhaps.

We do try to make as accurate a dx as possible.

Ian
04-14-05, 10:12 AM
Thank-you mctavish23. I'll use this often.

Drummergod35
04-17-05, 09:06 PM
Mc,


I am curious though as to why Mr. Castelanos or the NIMH itself wrote back to Dr. Baughman On May, 13, 1998, Castellanos or the NIMH wrote me: "… we have not yet met the burden of demonstrating the specific pathophysiology that we believe underlies this condition." How can this be? This is conflicting data. Can you exlpain this or : The final statement of the Consensus Conference Panel, delivered to attendees, and the press, November 18, 1998, read: "...we do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction." Sounds a little odd to me. And this: In January, 2000 Castellanos of the NIMH, summarized the state of ADHD science: "Incontrovertible evidence is still lacking…In time I’m confident we’ll confirm the case for organic causes."

This leaves me still puzzled.

Best,

Tim


You obviously havent read some of the most recent posts concerning whether or not ADHD is a "real disorder." First of all there are virtually no lab tests for depression;including all forms of Bipolar, Schizophrenia ( in all its forms) , Tourettes Syndrome.Obssesive Compulsive Disorder,etc. The exact etiology of ADHD is unknown.No one is claiming to know that, at least not right now. As far as your statements about there being "no scientific basis"(/B) for these disorders, you are completely mistaken.

Here's the "proof" : These are ALL from unrestricted research grants published in (the cream of the crop) peer reviewed journals.

1) The neurobiological nature of ADHD.....THE PROOF YOU SAY DOESNT EXIST: was conclusively proven in the 1990 landmark glucose brainscan research study published in the New England Journal of Medicine....


Zametkin,A.J.,Nordahl,T.E.,Gross,M.,King,A.K.,Semp le,W.E.,Rumsey,J.,Hamburger,S.,& Cohen,R.M.(1990) Cerebral glucose metabolism in adults with hyperactivity of childhood onset. The New England Journal of Medicine,323,(30).1361-1366.

The "proof" is in the PET scans that showed that the harder a person with ADHD concentrated the "slower" their brain went vs the exact opposite for the non ADHD group. However, that was remedied when the ADHD subjects took stimulant medication.

THE definitive study proving the existence of ADHD as a "real" disorder;signed off on by over 80 of the world's leading scientists (with over 19 pages of references) is :

Consortium of international scientists:International Consensus Statement on ADHD, January 2002. (http://www.chadd.org). It can also be viewed at Russell Barkley's website.


You can turn to pages 22-24 of Sandra Rief's 2003 book.............The ADHD Book of Lists ....................to find the section (1-7) WHAT THE RESEARCH IS REVEALING ABOUT ADHD

Within that section is the reference for the Landmark MTA Study:

"There has been significant research with regards to treatments for ADHD and their relative effectiveness. The longest and most thorough study of the effects of ADHD interventions was the 1999 Multimodal Treatment Study of Children with ADHD (MTA) by the National Institute of Mental Health (NIMH).

MTA Cooperative Group" A 14-month Randomized Clinincal Trial of Treatment Strategies for AD/HD,"Archives of General Psychiatry,[I] 56:1073-1086;1999.

ADHD is primarily thought to be largely (80%) genetic/inherited.THE GENETIC LANDMARK FOR ADHD WAS FOUND IN 995. That study is as follows:


Cook,et.al.,(1995) Association of attention-deficit disorder and the dopamine transporter gene.American Journal of Human Genetics,56.993-998.

The US Surgeon General's Report on Mental Health: Chapter 3: Disorders of Infancy, Childhood & Adolescence has excellent background info supporting in great detail (with another 19 pages of scientific references).Here's a small segment on what I'm talking about:
" The exact etiology of ADHD is unknown,although neurotransmitter deficits,genetics and perinatal complications have been implicated." It goes on to say:

"Research to pinpoint abnormal genes is honing in on 2 genes;a dopamine receptor gene (DRD) gene on chromosome 11 and the dopamine -transporter gene (DAT1) on chromosome 5 (Cook,et.al.,1995:Smalley,et.al.;1998).

The latter reference is : Smalley,et.at.(1998) Evidence that the dopamine D4 receptor is a succeptibility gene in attention-deficit hyperactivity disorder,Molecular Psychiatry,3,427-430.

Recently (3/25/05), I participated in a teleconference on ADHD in children put on by United Behavioral Health (UBH: a managed care company). The presenter was Russell Barkley, PhD. He is largely viewed as the world's leading researcher on ADHD. During that presentation, he listed the following (evidenced based/research derived) data regarding the neurology of ADHD.

Decreased Cerebral Metabolism
(from Thomas Spencer, M.D.)

global and regional glucose metabolism by PET scan reduced in adults who have been hyper since childhood (thats Zametkin's research again).
Largest reductions in:
1) pre motor cortex
2) superior prefrontal cortex

Anterior Cingulate Dysfunction in ADHD, fMRI and the Counting Stroop.
Bush,et.al.,(1998).


Etiologies-Neurological

Smaller, less active,less developed brain
Regions found on MRI,fMRI and PET scans incluse the following areas of the brain:
1) Orbital-Prefrontal Cortex( primarily on the right side)

2) Basal Ganglia (mainly striatum and globus pallidus)

3) Cerebellum (central vermis area, right side) - there were some other posts about this particualr area of the brain being a key component of ADHD in a different thread I believe

Suspected Neurochemical Deficiency:

1) Dopamine dysregulation likely but not definitive....... the mere fact that stimulant
medication works at all to relieve symptoms of ADHD forms a solid basis
for helping to substantiate this (and the first medication study was done in 1937 in
Rhode Island)

2) Norepinephrine dysregulation probable

Etiologies- Genetic ( these data were all derived from research studies) The usual maker for statistical significance is 1.5 SD (standard deviation) 's from the mean, which equates to a %tile ranking of 93. In other words, the absolute lowest chance of these data being accurate is 93%.

1) Family aggregation of the disorder: 25-35% of siblings; 78-92% of idnetical twins;15-20% of mothers, and 25-30% of fathers; If the parent is ADHD, then theres a 20-54% chance of the offspring being ADHD (increases the odds 8fold)

2) Twin studies of Heritability 57-97%)

3) Shared environment 0-6% (not significant)

4) Unique environment (15-20% )


Molecular Genetics : Candidate genes on DRD4,DAT1,DBH-Taq1 (on chromosomes 3,5,and 11)

Candidate region: chromosome 26p13 region


Lastly, the answer to your questions about the difference between ADHD and ADD can be found in Barkley's ADHD and the Nature of Self-Control (1997).
It's also addressed in his 2002 book Taking Charge of ADHD (pages 137-138) and in You Mean Im Not Lazy,Stupid Or Crazy? by Kate Kelly & Peg Ramundo (Chapter 2).

As for depression, it is considered to be a Medical disorder on the basis of the chemical imbalance of the neurotransmitter serotonin. I don't know anyone who considers it to be a "disease".

There's no cure for the common cold but people know it exists. The Biogenic Amine Hypothesis was derived (via research) over 20 years ago. Here's what that says: "The concept that abnormalities in the physiology and metabolism of certain biogenic amines, particularly catecholamines[I](norepinephrine and dopamine ) and an indoleamine(serotonin) , are involved in the causes and courses of certain psychiatric illnesses."
That qoute was from an older issue of A Psychiatric Glossary of the AMerican Psychiatric Association, page 28. The new one is at the office.

The Biogenic Amine Hypothesis is what eventually led to the development of the class of antidepressants we now know as SSRI's (Select Serotonin Reuptake Inhibitor's:Zoloft, Prozaz,etc.).


This MORE than refutes your remarks. As of the summer of 2003 there were over 6k research articles,professional papers, chapters in book and books on ADHD.

If you go to the International Consensus 2002 journal article, you will also find on page 89:

"ADHD is recognized as a disorder/medical condition by the American Medical Association, the American Psychiatric Association, the American Psychological Association and the American Academy of Pediatrics."


THIS ISN'T AN EXACT SCIENCE .NO ONE EVER SAID IT WAS. But I can tell you that a T score of 70+% on the Conners Parent Rating Scale is one of the most accurate predictors of ADHD currently available (when used in concert with a thorough developemental and medical screening, behavioral observations and other screenings for executive functions; to name a few).


I could go on but I've made my point. I spent hours on this post and still had to cut it short. There's your scientific basis.

Drummergod35
04-17-05, 09:17 PM
Also, as far as CHADD goes. I came across something written by the DEA it read:

"It has recently come to the attention of the DEA, the Ciba-Geigy (the manufacturer of the methylphenidate product marketed under the brand name Ritalin) contributed $748,000 to CHADD from 1991 to 1994. The DEA has concerns that the depth of the financial relationship with the manufacturer was not well-known by the public, including CHADD members that have relied upon CHADD for guidance as it pertains to the diagnosis and treatment or their children. A recent communication from the United Nations International Narcotics Control Board (INCB), expressed concern about non-governmental organizations and parental associations in the United States that are actively lobbying for the medical use of methylphenidate for children with ADHD. The INCB further stated that “financial transfer from a pharmaceutical company with the purpose to promote sales of an internationally controlled substance would be identified as hidden advertisement and in contradiction with the provisions of the 1971 Convention (Article 10, para 2).”



The Drug Enforcement Agency

I am suspicious about CHADD, just a little, so as far their "studies" go, I wonder how much money actually changed hands in the "research" process.

Best,

Tim