View Full Version : Is there a mild form of ADHD?


mildadhd
04-22-14, 09:33 PM
I was diagnosed moderate ADD.

Is there a less impairing form of ADHD?

Where is the line between impaired and not impaired?

What is the difference between "causing ADHD" and "making ADHD worse".

Either way, both seem equally important to try and prevent to me.




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Ganjin
04-22-14, 09:36 PM
As a spectrum disorder I have to think the answer is yes. That is, relatively mild. But technically must cause some level of dysfunction or it fails to meet diagnostic criteria.

mildadhd
04-22-14, 09:59 PM
As a spectrum disorder I have to think the answer is yes. That is, relatively mild. But technically must cause some level of dysfunction or it fails to meet diagnostic criteria.



I think everyone agrees that to much distress may make ADHD symptoms worse.

So, if a person with mild ADHD, is exposed to much distress, the severity of the ADHD impairment, may get worse?

I think it is possible.






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Ganjin
04-22-14, 10:02 PM
I think everyone agrees that to much distress can make ADHD symptoms worse.

If a person with mild ADHD, is exposed to much distress, I would the severity of ADHD impairment get worse?

I think it does.




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Yes that makes perfect sense. What's annoying tendencies one day can become disorder the next as circumstances change.

namazu
04-22-14, 11:29 PM
Where is the line between impaired and not impaired?
There is no hard and fast line. There are degrees of impairment, from "minimal" to "totally life-wrecking", and they depend in some respects on environment as well. A lot of the debate about whether ADHD is being overdiagnosed hinges on this very question.

What is the difference between "causing ADHD" and "making ADHD worse".

Either way, both seem equally important to try and prevent to me.
Also a tricky question, but I think you're right that it's important to look at ADHD in both ways, especially since we probably have more control over "not making ADHD worse".

You might enjoy / benefit from reading up on what epidemiologists call
"primary prevention" (= preventing a disease process from being set in motion in the first place)
"secondary prevention" (= early detection & intervention; preventing a disease from becoming symptomatic or worsening)
and
"tertiary prevention" (= mitigating symptomatic disease so that it won't cause additional health problems and/or life impairments)

Here's a short discussion of these types/levels of prevention from
Epidemiology (4th ed.) by Leon Gordis, published by Saunders Elsevier in 2009 (http://www.worldcat.org/title/epidemiology/oclc/156994580&referer=brief_results):
https://lh5.googleusercontent.com/-NgYjtePtagI/U1cx_ZRsjmI/AAAAAAAAI04/2BH0CH0I0Ss/s576/prevention1.jpghttps://lh5.googleusercontent.com/-ejemawabjbw/U1c2odnYO5I/AAAAAAAAI1M/iQMqqMCZhP4/s640/prevention2.jpg
Excerpt from pp.6-7. Sorry the copy quality isn't great; if you click the link to the book above, it will tell you what libraries near you have a copy.

Primary prevention is often most straightforward in terms of infectious diseases: if you don't get the germ, you don't get the disease it causes.

But with most chronic diseases / disorders, and even some infectious diseases, if you look at them in more detail, it's not so straightforward.

For ADHD, I think focusing on tertiary prevention and secondary prevention are most likely to provide real-world benefits to people with inborn tendencies or sensitivities like we see in ADHD.
(In my opinion, ADHD is still one of those "diseases we do not yet have the biologic, clinical, and epidemiologic data on which to base effective primary prevention programs", not to mention that some risk factors may be truly unavoidable.)

So, these types of prevention / mitigation might be things like:
- helping parents understand how to deal with challenging behaviors in an effective, humane manner (tertiary prevention)
- medication where appropriate (secondary-ish prevention)
- educational accommodations (tertiary prevention)
- providing support for people with ADHD and their caregivers / families / etc.
- etc.

dvdnvwls
04-23-14, 02:31 AM
Where is the line between impaired and not impaired?

Impairment equals detrimental effect on the person's ability to function.

It's a foggy area, because there are people who (by planning or by luck) end up in a situation where some of their deficient functions have few demands placed on them, or where those tasks are done by others, thus "covering up" their ADHD; and there are other people who have their ADHD "covered up" by parents and teachers in childhood, and whose ADHD is therefore suddenly exposed when they leave home or school.

Nicksgonefishin
04-23-14, 02:41 AM
You're trying to quantity perception....

The severity as to which one is affected is his or her own perception.

I just have adhd. It's mildly severe. Jungian adhd perhaps...

mirandatoritess
04-23-14, 04:02 AM
yes it is a spectrum disorder.
Also different aspects of ADHD can be severe or mild

sarahsweets
04-23-14, 05:59 AM
I am not trying o hijack the thread or turn this into anything but the best way I can explain it for myself is this way: If you look at addiction as a disease then the symptoms of addiction (alcoholisim,drug abuse,gambling,sex,internet etc) would be like the symptoms. So someone with a sex addiction may not have as much impairment in their life if they have willing partners and no emotional ties to ruin with their addiction while someone with a drug addiction may resort to stealing or breaking the law to fund their addiction. Both are equally hard and difficult just in different ways. The same is true IMO with adhd. Someone may be able to find that niche in life where their off the wall thinking works for them or have very willing partners to pick up the pieces whereas some of use will have left nothing but destruction in our wake. I have no science to back this up and like I said I am not trying to correlate the two is just what helps me explain my point.

daveddd
04-23-14, 06:10 AM
almost all disorders in the dsm are far ends of normal human behavior

so i would say yes

someothertime
04-23-14, 12:18 PM
For me the question of impairment leads moreso from maladaptive coping mechanisms ( hence concurring with namazu's usggestions on intervention ) rather than severity of the actual ADHD. This is, of course, with reference to DSM categorisation and not individual practical experience...

i.e.

Someone could be severely ADHD and have a successful life given appropriate channelling and outlet... conversely, someone could have mid-mild ADHD and develop some seriously poor coping mechanisms ( learned comorbid behaviors ) that are severely restrictive on a "living" aka "diagnosis" sense...

Though, it would be very interesting to explore this in greater detail with better scholarly attention and health care system collaboration to better highlight which feeds which at what stage and so forth...

mildadhd
04-23-14, 01:19 PM
For me the question of impairment leads moreso from maladaptive coping mechanisms ( hence concurring with namazu's usggestions on intervention ) rather than severity of the actual ADHD. This is, of course, with reference to DSM categorisation and not individual practical experience...

i.e.

Someone could be severely ADHD and have a successful life given appropriate channelling and outlet... conversely, someone could have mid-mild ADHD and develop some seriously poor coping mechanisms ( learned comorbid behaviors ) that are severely restrictive on a "living" aka "diagnosis" sense...

Though, it would be very interesting to explore this in greater detail with better scholarly attention and health care system collaboration to better highlight which feeds which at what stage and so forth...

Thanks SomeOtherTime and Everyone. Great thoughts.

I think Namazu has also found some terms to help with the ideas and organize the discussion


Primary Prevention

Secondary Prevention

Tertiary Prevention


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ginniebean
04-23-14, 01:46 PM
You're trying to quantity perception....

The severity as to which one is affected is his or her own perception.

I just have adhd. It's mildly severe. Jungian adhd perhaps...

I find it difficult to understand why impairment is so often seen as entirely subjective.

Dr asks, how many jobs have you had?

Answer: well I just did 7 years of taxes that I procrastinated. My sister did them for me. I had 17 jobs in 7 years

Impairment shows up in an interview. Anyone who diagnosis without looking for well beyond the norm (2 standard deviations) is not competent or irresponsible. There are very specific and predictable evidence of impairment and any qualifies person will know what to look for. For me, my family hounding me for years to get treatment. Demanding to go with me so I wouldn't downplay or forget would also be evidence.

It's not just a subjective list of symptoms. There is one amazingly good psychiatrist in Canada (and I'm sure more) who has said he rules out adhd in 80% of adults who come thinking they might have it. He looks for what else might be going on and makes suggestions for follow up for the person.

Russell Barkley has spoken of when adhd runs in families genetically that most of the family members have the symptoms (including himself) however they don't meet the criteria for impairment. 80% of a family can be sub-threshold for adhd and yes because the unnamed sub-threshold people do not have the full on disorder they can under great stress have worsened symptoms and for periods in their lives cross the threshold into disorder. However, it's because it's already there, just not severe enough to wreck their lives.

mildadhd
04-23-14, 02:21 PM
Nothing Concrete, posting ideas for opinions and discussion.



1)Age of the individual is very important to recognize when discussing prevention of ADHD.


-Primary Prevention of ADHD (before birth)

-Secondary Prevention of ADHD (before the age of 4)

-Tertiary Prevention of ADHD (after the age of 4)




(Side Note: Unless specified the severity of ADHD spectrum being discussed, will assumed to be a mild form of ADHD)



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mildadhd
04-23-14, 03:40 PM
..the unnamed sub-threshold people do not have the full on disorder they can under great stress have worsened symptoms and for periods in their lives cross the threshold into disorder. (-GinnieBean)

Thanks,

In GinnieBean's example above, lessening unintentional distressful factors, may help prevent a person with mild ADHD from crossing the threshold into more severe impairment..

Lessening the unintentional distressful factors, would lessen the rise in severity, and lessen the chance of the person meeting criteria for diagnoses of an impairment.


In this example there is a possibility of some prevention at the primary prevention level, secondary prevention level and tertiary prevention level.

The actual possibilities of prevention depend partly on the age of individual, in this example.

Open for discussion.




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Nicksgonefishin
04-23-14, 04:06 PM
I find it difficult to understand why impairment is so often seen as entirely subjective.


It is how I rationalize how there can be persons with ADHD that are so successful. It gives me hope because if they can be that functional then so can I. The subjectiveness I was refering to is how badly one FELT they were disordered.

I agree with the other posts about the negative coping mechanisms being the biggest factor in measuring severity. But in this case one isn't measuring the ADHD itself but rather the coping mechanisms.

If only we could measure our individual disconnect from our prefrontal cortexes.... (I origionally spelled that cotexes LOL. Brain tampons! Ha!)

Stevuke79
04-23-14, 04:34 PM
I'm not sure if this is where peripheral was going, but to me it seems like we're getting at the idea that severity of the ADHD does not equal the severity of the impairment, and there are outside factors that influence impairment but not the ADHD itself.

Unfortunately this can also have a big impact on diagnosis. If someone doesn't appear impaired then they may not get diagnosed or treated. You may have someone who is very intelligent functioning at an average level due to ADHD, and a doctor may fail to recognize that he is indeed impaired, diagnosable and even treatable.

Dizfriz
04-23-14, 05:01 PM
I'm not sure if this is where peripheral was going, but to me it seems like we're getting at the idea that severity of the ADHD does not equal the severity of the impairment, and there are outside factors that influence impairment but not the ADHD itself.You have this quite accurate as I understand you.

Unfortunately this can also have a big impact on diagnosis. If someone doesn't appear impaired then they may not get diagnosed or treated. This is very true. We cannot give a diagnosis of ADHD without impairment. However in the DSM-IV there is a diagnosis which can cover this: Attention-Deficit/Hyperactivity Disorder NOS 314.9. This is for those who have impairments from ADHD symptoms but for whatever reason do not fall within the guidelines for a full diagnosis. (too lazy right now to look it up in the 5)

This DX allows the person to be treated without the full diagnosis based on clinical judgement .

It is a real problem without a real good solution.


Dizfriz

Lunacie
04-23-14, 05:29 PM
You have this quite accurate as I understand you.

This is very true. We cannot give a diagnosis of ADHD without impairment. However in the DSM-IV there is a diagnosis which can cover this: Attention-Deficit/Hyperactivity Disorder NOS 314.9. This is for those who have impairments from ADHD symptoms but for whatever reason do not fall within the guidelines for a full diagnosis. (too lazy right now to look it up in the 5)

This DX allows the person to be treated without the full diagnosis based on clinical judgement .

It is a real problem without a real good solution.


Dizfriz

I thought I'd read it was called "borderline ADHD" but I couldn't find any info on that.

Don't know why I didn't think of the NOS ... should have since my granddaughter has a dx of Autism NOS.

ginniebean
04-23-14, 06:21 PM
I have 3 sisters and 1 brother. All of them hyper focus, all of them walk into a room going, what was it I came here for. They have some of the symptoms but their symptoms are not as frequent, not severe enough for any diagnosis. They are all very successful people. They all had a stressful childhood, raised by the same parents and yet they don't have adhd.

They don't have adhd because whole they have the genetics most likely the impairment from it is minor. Now of their 8 children and my 2 we have 6 diagnosed with adhd and one with autism. All of our children had stable living home lives with supportive parents. Something we didn't have. Sub-threshold symptoms need massive life stressed to bump up to threshold. What I am seeing proposed is minor irritations and typical life stressors being suggested that this can cause the threshold to be crossed and this just has no evidence. There are cases where people would fall into a sub threshold category because they are short a symptom or two, they get a diagnosis because they are impaired enough to warrant a diagnosis.

Just because someone has tendencies for adhd symptoms doesn't mean stress will push them across a diagnose threshold.

And it's very likely to only happen in teens and adults. I'd a child crosses the threshold the stress needs to be severe and they's go below threshold when the stress let up again.

mildadhd
04-23-14, 08:16 PM
I understand Dr.Barkley's own research to say, that psychological development, is most influenced by the early environment.

And psychological development is less influenced by the environment as we age, after the age of 7.

That idea seems consistent with the current early brain development research.

I don't think environmental influence, is limited to parental influence.


"..we are able to calculate how much of their behavior, is due to parenting, within family environment.

And here is what we find.

The peak years of parental influence are below 7, from 7 up to 12, it drops dramatically .

After 15 is 6%.

6% of the variation in a teenagers behavior is how their parents raised them.

That's it and after age 21 it is zero.

There is no influence of parenting on any psychological trait, after the age of 21."



-Dr.Barkley, "Essential Ideas for Parenting", Youtube (2:04:43)


i!i

mildadhd
04-23-14, 10:07 PM
(Nothing concrete)

We are all in the tertiary level of prevention, after the age of 12.


Primary Prevention of ADHD. (before birth*)

-any known factors, that maybe removed from the environment or added to the environment, that may prevent an emotionally hypersensitive AD(H)D temperament from emerging.


Secondary Prevention of ADHD. (before the age of 4*)

-any known factors, that may be removed from the environment or added to the environment, that may lessen the severity of emerging ADHD symptoms, due to being born with a emotionally hypersensitive AD(H)D temperament. (including primary prevention factors)


Tertiary Prevention of ADHD (after the age of 4-7-12-adulthood*)

-any known factors, that may be removed from the environment or added to the environment, that may lessen the impact of living with ADHD symptoms/emotionally hypersensitive temperament.(including primary prevention factors and secondary prevention factors)




*(Give or take)

Greyhound1
04-23-14, 10:53 PM
Thanks,

In GinnieBean's example above, lessening unintentional distressful factors, may help prevent a person with mild ADHD from crossing the threshold into more severe impairment..

Lessening the unintentional distressful factors, would lessen the rise in severity, and lessen the chance of the person meeting criteria for diagnoses of an impairment.


In this example there is a possibility of some prevention at the primary prevention level, secondary prevention level and tertiary prevention level.

The actual possibilities of prevention depend partly on the age of individual, in this example.

Open for discussion.




P

I know for me the severity of my ADHD is directly connected with my stress and anxiety levels.

Lunacie
04-23-14, 10:57 PM
Thanks,

In GinnieBean's example above, lessening unintentional distressful factors, may help prevent a person with mild ADHD from crossing the threshold into more severe impairment..

Lessening the unintentional distressful factors, would lessen the rise in severity, and lessen the chance of the person meeting criteria for diagnoses of an impairment.


In this example there is a possibility of some prevention at the primary prevention level, secondary prevention level and tertiary prevention level.

The actual possibilities of prevention depend partly on the age of individual, in this example.

Open for discussion.




P

How would one identify those factors if they are unintentional?

mildadhd
04-23-14, 11:17 PM
How would one identify those factors if they are unintentional?

Of the top of my head...

Anxiety, Depression, Adoption, Addiction, Financial/job loss,Chemical Exposure, PTSD, Divorce, Loss of a family member, Heredity, Family Emergency, and other types of emotional health issues, are some possible types of unintentional emotional distress.

Unintentional, meaning nobody wanted them to happen.


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ginniebean
04-23-14, 11:51 PM
Thanks,

In GinnieBean's example above, lessening unintentional distressful factors, may help prevent a person with mild ADHD from crossing the threshold into more severe impairment..


No Peripheral in my example a person who does NOT have ADHD but has a genetic predisposition could under EXTREME stress cross the clinical threshold to become a disorder.

No impairment, no disorder. That extreme stress would likely be largely unpredictable with tragic life events. I was not speaking of this happening to a small child. Such traumatic events to cause sub threshold symptoms to become full blown disorder have to be in the neighbourhood of abuse, or some other trauma, and when the child was safe and unstressed the symptoms would go subthreshold again. It's not that the child would remain at clinical levels or anyone would. Stress can make our symptoms worse. Stress makes everyone's life worse. People with it in their genetic tree and have well below threshold adhd may go above threshold temporarily not permanently.

Abi
04-24-14, 12:20 AM
MODERATOR'S NOTE: The discussion of PTSD and its relationship with ADHD that followed this post has been split off to its own thread (http://www.addforums.com/forums/showthread.php?t=161122) to keep this thread focused on ADHD, determining when impairment becomes disorder, and strategies for prevention.

No Peripheral in my example a person who does NOT have ADHD but has a genetic predisposition could under EXTREME stress cross the clinical threshold to become a disorder

Note that there is a disorder called PTSD which has this aetiology. Bear in mind also that executive dysfunction and emo dysregulation are amoung the symptoms of PTSD.

PTSD is not treated with stimulant medication. It is most responsive to SSRIs and mood stabilisers like Depakene and Risperdal, as well as psychotherapy. By contrast, ADHD is responsive to stimulants like Ritalin, and not responsive to SSRIs, mood stabilisers, or psychotherapy.

mildadhd
04-24-14, 01:12 AM
The threshold seems like a constant, between, sub-threshold and impairment?


subthreshold(mild form of ADHD)-------threshold--------impairment(moderate or higher forms of ADHD severity)


Side Note: The person in my examples, with a mild form of ADHD, is almost on the threshold, and carries variations of every ADHD genetic predisposition, known.



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daveddd
04-24-14, 05:54 AM
No Peripheral in my example a person who does NOT have ADHD but has a genetic predisposition could under EXTREME stress cross the clinical threshold to become a disorder.

No impairment, no disorder. That extreme stress would likely be largely unpredictable with tragic life events. I was not speaking of this happening to a small child. Such traumatic events to cause sub threshold symptoms to become full blown disorder have to be in the neighbourhood of abuse, or some other trauma, and when the child was safe and unstressed the symptoms would go subthreshold again. It's not that the child would remain at clinical levels or anyone would. Stress can make our symptoms worse. Stress makes everyone's life worse. People with it in their genetic tree and have well below threshold adhd may go above threshold temporarily not permanently.

do you have evidence for this?

you would be surprised what could push a child into coping mechanisms (disorder)

Amtram
04-24-14, 07:43 AM
(Nothing concrete)

We are all in the tertiary level of prevention, after the age of 12.


Primary Prevention of ADHD. (before birth*)

-any known factors, that maybe removed from the environment or added to the environment, that may prevent an emotionally hypersensitive AD(H)D temperament from emerging.


Secondary Prevention of ADHD. (before the age of 4*)

-any known factors, that may be removed from the environment or added to the environment, that may lessen the severity of emerging ADHD symptoms, due to being born with a emotionally hypersensitive AD(H)D temperament. (including primary prevention factors)


Tertiary Prevention of ADHD (after the age of 4-7-12-adulthood*)

-any known factors, that may be removed from the environment or added to the environment, that may lessen the impact of living with ADHD symptoms/emotionally hypersensitive temperament.(including primary prevention factors and secondary prevention factors)




*(Give or take)

How do you prevent a condition that's pre-existing at birth?

namazu
04-24-14, 09:36 AM
How do you prevent a condition that's pre-existing at birth?

If you look at the definitions of "secondary prevention" and "tertiary prevention", you'll see that they refer to prevention / mitigation of problems resulting from a condition that a person already has, but which may not be symptomatic or which may have preventable "downstream" consequences.

To the extent that prenatal environmental exposures could contribute to the etiology of ADHD, reducing those exposures could be a form of primary prevention. (Eugenics need not apply...)

Dizfriz
04-24-14, 10:05 AM
If you look at the definitions of "secondary prevention" and "tertiary prevention", you'll see that they refer to prevention / mitigation of problems resulting from a condition that a person already has, but which may not be symptomatic or which may have preventable "downstream" consequences.

To the extent that prenatal environmental exposures could contribute to the etiology of ADHD, reducing those exposures could be a form of primary prevention. (Eugenics need not apply...)
Did you see on Cosmos the story of reducing lead in the environment? A very good example and we know lead exposure can be a significant cause of ADHD symptoms.

Dizfriz

Amtram
04-24-14, 11:04 AM
Except that if you look at the graphs together, you'll see lead exposure decreasing and ADHD diagnoses increasing. Reverse correlation. Of course lead is a dangerous neurotoxin - but you can't blame it for ADHD if removing it from the atmosphere doesn't decrease ADHD levels correspondingly.

Dizfriz
04-24-14, 11:25 AM
Except that if you look at the graphs together, you'll see lead exposure decreasing and ADHD diagnoses increasing. Reverse correlation. Of course lead is a dangerous neurotoxin - but you can't blame it for ADHD if removing it from the atmosphere doesn't decrease ADHD levels correspondingly.
True, and you got me there. I was relating to it as a primary method of prevention and did not think it though enough for its effects on ADHD in the population.

Dizfriz

mildadhd
04-24-14, 11:36 AM
I think Dizfriz is right, lead (type of chemical exposure) is one possible factor.

But I don't think lead exposure is the only possible ADHD factor, that may be lessened or prevented.

(I don't think that exposure to lead is a factor in all cases of ADHD, but may be a possible factor in some cases of ADHD.)





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