View Full Version : Pediatric traumatic brain injury and attention deficit


peripatetic
08-12-15, 11:48 PM
there's a new study published that the Washington post reported under the title "a new type of ADHD" http://www.washingtonpost.com/news/to-your-health/wp/2015/08/03/a-new-type-of-adhd-head-injuries-in-children-linked-to-long-term-attention-problems/

I read the article I linked above as well as the abstract linked below. I didn't read the full study, though I believe you can access it for free if someone wants to.

From the abstract I didn't get the sense that it was, as the title of the post suggested, a new type of "ADHD" per se, but perhaps that's because ADHD, the term, wasn't used by the authors of the study.

That said, I wonder if the same treatments would help persons with TBI? Obviously this is one study and they're not going to rewrite the dsm over it, but it does make me think, so thought I'd share.

http://m.pediatrics.aappublications.org/content/early/2015/07/28/peds.2015-0437.abstract

daveddd
08-12-15, 11:59 PM
i agree that i don't think its a new type, i think ADHD by TBI has always been considered ADHD

same treatments helpful?

to answer that i would just want to see (probably nonsense) a well designed study to differ "hot " and "cold" EFs

that could be useless though, if we don't know if the damaged part of the brain is the PFC or the limbic system or if what we know about either is accurate

phineas gage is of interest in this question right?

peripatetic
08-13-15, 12:13 AM
Yes! Phineas gage was what sprung to mind for me, too.

I was thinking similarly that TBI and attention problems were a known link, but I find it interesting that the way the post reported it was as a new type of ADHD.

On the one hand, maybe that's the reporter's conflation of "an attention deficit" with "attention deficit hyperactivity disorder". We know many things can give symptoms including attention problems and not be ADHD. Or maybe a/he wanted an attention grabbing title (since I started this thread...I'd say that was a success).

On the other hand, "what makes something ADHD?" is a question that's been debated frequently. If these TBI sufferers end up meeting criteria, then it seems appropriate to include TBI as a factor in ADHD.

That's why I asked about treatment response, because maybe that ends up being how what is or isn't a possible "type" of ADHD is decided.

It also just occurred to me that if the injuries happen at a very young age, there must be some percentage who would have ADHD apart from the injury, you know? I mean, if it's found in five or six or whatever percent of the population, then wouldn't it be, if the injury sent happened, in that same rough percentage of those with TBI?

daveddd
08-13-15, 12:17 AM
Yes! Phineas gage was what sprung to mind for me, too.

I was thinking similarly that TBI and attention problems were a known link, but I find it interesting that the way the post reported it was as a new type of ADHD.

On the one hand, maybe that's the reporter's conflation of "an attention deficit" with "attention deficit hyperactivity disorder". We know many things can give symptoms including attention problems and not be ADHD. Or maybe a/he wanted an attention grabbing title (since I started this thread...I'd say that was a success).

On the other hand, what makes something ADHD? If these TBI sufferers end up meeting criteria, then it seems appropriate to include TBI as a factor in ADHD.

That's why I asked about treatment response, because maybe that ends up being how what is or isn't a possible "type" of ADHD is decided.

It also just occurred to me that if the injuries happen at a very young age, there must be done percentage who would have ADHD apart from the injury, you know? I mean, if it's found in five or six or whatever percent of the population, then wouldn't it be, if the injury sent happened, in that same rough percentage of those with TBI?

yea, like a double ADHD?

I'm sure there are differences that can be teased out

namazu
08-13-15, 12:22 AM
It's an interesting issue.

Kids with ADHD are also more likely to get into accidents and incur head trauma. Because of this predisposition, it can be tricky to get at the relationship between head trauma and later ADHD-ish problems; teasing out what may be due to pre-existing ADHD (or subclinical ADHD-ish presentation) and what's due to the effects of head trauma isn't easy, especially if thorough pre-accident baseline data on a kid's cognitive (etc.) functioning are unavailable.

The authors of this study compared kids with TBI to kids with non-head-trauma injuries, which may help control for that somewhat -- these are all kids who've had accidents/injuries of one sort or another. It would help to know how the kids' head trauma was caused, and what were the range of causes of the other kids' injuries. If you're comparing impulsive kids with head injuries to impulsive kids with broken bones, that might not be a bad comparison. If the control group is composed of kids with primarily sports injuries, or passengers in car accidents, then maybe not.

There have been a few studies looking at stimulants as potential treatments for TBI-related cognitive and behavioral consequences, but I don't remember off-hand what the findings were. I kinda vaguely think that the meds seemed helpful in some cases, but I'm pulling that out of my own faulty memory, so don't quote me on that.

There's definitely a lot of overlap, especially with frontal lobe injuries.

And it can go both ways, too. I've found that the suggestions on a site dedicated to kids/teens with head injuries (http://projectlearnet.org/tutorials.html) are often right on point for addressing ADHD-related issues as well.

daveddd
08-13-15, 12:32 AM
Brain Inj. 2014;28(11):1461-72. doi: 10.3109/02699052.2014.930179. Epub 2014 Jul 2.
Traumatic brain injury-related attention deficits: treatment outcomes with lisdexamfetamine dimesylate (Vyvanse).
Tramontana MG1, Cowan RL, Zald D, Prokop JW, Guillamondegui O.
Author information
Abstract
BACKGROUND AND OBJECTIVES:
Attention deficits are often among the most persistent and debilitating impairments resulting from traumatic brain injury (TBI). This study examined the effects of lisdexamfetamine dimesylate (Vyvanse) in treating attention deficits due to moderate-to-severe TBI. It was the first study of lisdexamfetamine dimesylate with this population and, in fact, was the first controlled trial in this area examining a stimulant medication option other than methylphenidate.
METHODS:
This was a 12-week, randomized, double-blind, placebo-controlled, cross-over trial. A total of 22 rigorously selected cases were enrolled, 13 of whom completed the trial. They were 16-42 years of age and had newly acquired attention deficits persisting for 6-34 months post-injury. They were assessed on a broad range of neuropsychological and behavioural measures at baseline, 6-weeks and at 12-weeks.
RESULTS AND CONCLUSIONS:
Positive treatment effects were found involving selective measures of sustained attention, working memory, response speed stability and endurance and in aspects of executive functioning. No major problems with safety or tolerability were observed. Some moderating treatment effects were found from a broad range of pre-treatment subject characteristics and injury variables examined. Avenues for further research and treatment applications in this area are discussed.
KEYWORDS:
Attention-deficit/hyperactivity disorder; head injury; neuropsychological effects; stimulant me





bleh

peripatetic
08-13-15, 12:37 AM
It's an interesting issue.

Kids with ADHD are also more likely to get into accidents and incur head trauma. Because of this predisposition, it can be tricky to get at the relationship between head trauma and later ADHD-ish problems; teasing out what may be due to pre-existing ADHD (or subclinical ADHD-ish presentation) and what's due to the effects of head trauma isn't easy, especially if thorough pre-accident baseline data on a kid's cognitive (etc.) are unavailable.

Well put. Though less articulately, that's what I was getting at with there being kids with TBI who were already ADHD bound, so to speak. And how to get a good control group if we don't know the exact cause to begin with. Especially since, as you noted, ADHD and being more accident prone go hand in hand.

daveddd
08-13-15, 12:45 AM
JAMA Pediatr. 2015 Apr;169(4):391-5. doi: 10.1001/jamapediatrics.2014.3275.
Injury prevention by medication among children with attention-deficit/hyperactivity disorder: a case-only study.
Mikolajczyk R1, Horn J2, Schmedt N3, Langner I3, Lindemann C4, Garbe E5.
Author information
Abstract
IMPORTANCE:
Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of injuries. Attention-deficit/hyperactivity disorder is often treated with medication, but the evidence regarding prevention of injuries is inconclusive.
OBJECTIVE:
To determine via a case-only design whether the use of methylphenidate hydrochloride or atomoxetine hydrochloride reduces the risk of injuries among children and adolescents with ADHD.
DESIGN, SETTING, AND PARTICIPANTS:
We used the German Pharmacoepidemiological Research Database, which includes records from about 17 million insurees (approximately 20% of the population) from 4 statutory health insurance providers in Germany to identify children aged 3 to 17 years with new diagnoses of ADHD in 2005 and 2006. We identified 37,650 children with ADHD based on inpatient and outpatientdiagnostic codes (F90.0, F90.1, and F90.9) from the German modification of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Among them, we identified those with an inpatient injury diagnosis during follow-up until 2009. A total of 2128 children with any injury diagnosis at hospitalization, 821 of whom had a brain injury diagnosis, were included in the analysis. We applied the self-controlled case series design to control for time-invariant characteristics of the patients and time trends in the exposure.
EXPOSURES:
Treatment with methylphenidate or atomoxetine based on prescription data.
MAIN OUTCOMES AND MEASURES:
Hospitalization because of any injury or brain injury according to the injury mortality diagnosis matrix.
RESULTS:
Incidence rate ratios for the periods with medication compared with nonmedicated periods were 0.87 (95% CI, 0.74-1.02) for hospitalization with any injuries and 0.66 (95% CI, 0.48-0.91) for brain injuries only in the full sample. These estimates remained stable in sensitivity analyses restricting the sample to a narrower age range or to patients with a single hospitalization. There was no indication that medication prescriptions are increased after hospitalizations.
CONCLUSIONS AND RELEVANCE:
No significant risk reduction for hospitalizations with injury diagnoses was observed during periods of ADHD medication, but there was a preventive effect on the risk of brain injuries (34% risk reduction). The effects were controlled for time-invariant characteristics of the patients by the study design.



coming from a bit of a simpleton , the ADHD could have been there ahead of time

and even treatment doesn't prevent the likelihood of us knocking ourselves out but helps the outcome?

namazu
08-13-15, 12:52 AM
Somewhat tangential, but I think that there's been an uptick in interest in this issue because of the recent revelations about concussions in sports and long-term effects of sports-related head injuries.

There's been a push for more comprehensive pre-testing of college-level athletes, especially, to enable detection of acute or long-term consequences of sports-related brain injuries. Also, this kind of thing has been brought into the on-field assessments of athletes who're suspected of having concussions.

The increasingly sophisticated field medicine in military settings is also saving many military personnel with head injuries (and often multiple injuries) who in days of yore would not have survived. This has also spurred some research into rehabilitation and treatment strategies for TBI.

You raised an important point, Peri, about "attention deficits" (which, as a generic, are common in brain injuries as well as numerous neuro/psych disorders) vs. "ADHD" (as a stand-alone disorder) and the funny business of labeling. This is one of the reasons I think the shift towards dimensional assessment of symptoms/functioning is worthwhile. To the extent that overlapping symptoms may reflect overlapping physiology, and to the extent that there may be some commonalities in effective treatment approaches, maybe the exact labels aren't so important. On the other hand, sometimes things that look similar on the outside may be caused by different processes. So definitely another open and very important area of research.

Daveddd, thanks for following up on my vague recollection! I think there may be a paper or two on methylphenidate as well. I know there have been some parents of kids with head injuries here who've asked about stimulants' effects for indications beyond simple ADHD.

namazu
08-13-15, 01:06 AM
EXPOSURES:
Treatment with methylphenidate or atomoxetine based on prescription data.
MAIN OUTCOMES AND MEASURES:
Hospitalization because of any injury or brain injury according to the injury mortality diagnosis matrix.
RESULTS:
Incidence rate ratios for the periods with medication compared with nonmedicated periods were 0.87 (95% CI, 0.74-1.02) for hospitalization with any injuries and 0.66 (95% CI, 0.48-0.91) for brain injuries only in the full sample. These estimates remained stable in sensitivity analyses restricting the sample to a narrower age range or to patients with a single hospitalization. There was no indication that medication prescriptions are increased after hospitalizations.
CONCLUSIONS AND RELEVANCE:
No significant risk reduction for hospitalizations with injury diagnoses was observed during periods of ADHD medication, but there was a preventive effect on the risk of brain injuries (34% risk reduction). The effects were controlled for time-invariant characteristics of the patients by the study design.



coming from a bit of a simpleton , the ADHD could have been there ahead of time

and even treatment doesn't prevent the likelihood of us knocking ourselves out but helps the outcome?

If I'm reading this right, in this study, the researchers identified kids who already had a diagnosis of ADHD, and then followed them for about 3-4 years. (So the ADHD was indeed already there!) The researchers were also able to get records of each kid's medication treatment over that time period, as well as records of injury-related hospitalizations. Then they could look to see whether any given kid was prescribed meds at the time of the injury.

Although the result wasn't quite statistically significant, they actually did observe about a 10% lower risk of hospitalizations for general injuries while kids were taking meds. There was an even greater reduction in head injuries among kids taking meds (medicated kids about 2/3 as likely as non-medicated kids to be hospitalized for head injury).

It's worth noting -- the authors only knew if a kid was prescribed meds over the period of time when the injury occurred -- not whether the kid was actually taking meds at the exact time of the injury. If they could have measured that accurately, they might have found larger effects.)

It's interesting that they didn't see any increase in medication use following injuries.

sarahsweets
08-13-15, 03:49 AM
As an aside I think there has been a lot of invalidation on the links between tbi and effects, at least in my experience. Almost like people refuse to acknowledge the extent of neurological damage that can be caused.

daveddd
08-13-15, 05:41 AM
If I'm reading this right, in this study, the researchers identified kids who already had a diagnosis of ADHD, and then followed them for about 3-4 years. (So the ADHD was indeed already there!) The researchers were also able to get records of each kid's medication treatment over that time period, as well as records of injury-related hospitalizations. Then they could look to see whether any given kid was prescribed meds at the time of the injury.

Although the result wasn't quite statistically significant, they actually did observe about a 10% lower risk of hospitalizations for general injuries while kids were taking meds. There was an even greater reduction in head injuries among kids taking meds (medicated kids about 2/3 as likely as non-medicated kids to be hospitalized for head injury).

It's worth noting -- the authors only knew if a kid was prescribed meds over the period of time when the injury occurred -- not whether the kid was actually taking meds at the exact time of the injury. If they could have measured that accurately, they might have found larger effects.)

It's interesting that they didn't see any increase in medication use following injuries.

yea the study seems hard to interpret

it just happened to be in the links from the other study


i thought it may have been supporting your theory of ADHD kids being more vulnerable to injury as a correlation not a cause


the lack of medication increases after injuries i assumed meant no new ADHD cases, just preexisting

SB_UK
08-13-15, 09:26 AM
i thought it may have been supporting your theory of ADHD kids being more vulnerable to injury as a correlation not a cause



This ^^^ assessment is correct.

Our ADDer is much more vulnerable to injury through recognized aspects of ADHD.

Clumsiness (falls over frequently) <- note - cerebellar education/learning/training/development
Inattention (always bumping into other people) <- note - sensory overload (to be handled by a cerebellum (cerebellar-cortical loops tie sensory and motor signals together - signals unhandled till loops in place) ... ... when ready)

Just what you'd expect of a 5 or 6 year old in the body of a 9 or 10 year old.

Increased time taken in ADDers for cortical maturation - must mean cerebellar-cortical loop formation.

KarmanMonkey
08-13-15, 10:40 AM
I'd be hesitant to refer to any TBI as ADHD for a couple reasons:

1) ADHD is more complex than simply being an issue with the frontal lobe,
2) TBIs tend to have a much different set of approaches that are effective than for people born with ADHD,
3) I think this could lead to more stigma with ADHD "Oh, so you're brain damaged"

Fuzzy12
08-13-15, 11:24 AM
I'd be hesitant to refer to any TBI as ADHD for a couple reasons:

1) ADHD is more complex than simply being an issue with the frontal lobe,
2) TBIs tend to have a much different set of approaches that are effective than for people born with ADHD,
3) I think this could lead to more stigma with ADHD "Oh, so you're brain damaged"

I think, currently what exactly causes ADHD is not understood well enough to be able to say what exactly is or isn't ADHD. I see it more as a set of symptoms most probably resulting from a particular common physiological or anatomical difference to non-ADHD brains.

I'm sure that not all traumatic brain injuries cause exactly the same symptoms of ADHD or exclusively these symptoms but isn't it possible that in some brain injuries the structures that got damaged are the same as the ones that give rise to symptoms of ADHD (e.g. prefrontal cortex).

Regarding stigma, I do see ADHD as a form of brain damage, or at least as having a brain that is suboptimal compared to that of the norm. Also, if being labelled as "brain damaged" results in stigma and possible discrimination, prejudice or any sort of negative treatment then people with TBI shouldn't have to deal with that stigma either. I mean, I guess, the problem is more then that people stigmatise brain damage rather than ADHD having a stigma because it's associated with brain damage. I'm guessing that's not what you mean but to me it sounds a bit like saying don't die your hair black or get tanned because then you will have to deal with racism....

Pilgrim
08-13-15, 03:06 PM
The only reason that they compare ADD to Tbi is the treatment options? Isn't this correct.

I remembered one interesting thing though. I recently worked with this woman who told me the story of her son who had had an injury when a child, they had given him Dex and he had taken it for a number of years and now refused to take it and was now a real handful, he's about 18 now.
As I got to know this lady and meet her husband they were both obviously ADD. I just thought it was interesting.

mildadhd
08-13-15, 09:04 PM
My layhuman understandings are, there are no brain parts damaged/scar tissue in a ADHD.



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mildadhd
08-13-15, 10:11 PM
http://adriandayton.com/wp-content/uploads/2010/02/triune-brain.gif

An iron rod went through Phineas Gage's left frontal lobe (see upper orange/green parts of the triune brain), but he still had consciousness.

If the same iron rod destroyed the deep subcortical midbrain areas of Phineas Gage's brain, he would not have any consciousness at all. (see hotpink parts of the triune brain).

And if Phineas Gage's damage was limited (~5% ) to the tertiary right prefrontal and lower connecting secondary parts to a lesser degree (see orange and green), Phineas Gage may have appeared to have a ADHD.

P

KarmanMonkey
08-14-15, 11:16 AM
I think, currently what exactly causes ADHD is not understood well enough to be able to say what exactly is or isn't ADHD. I see it more as a set of symptoms most probably resulting from a particular common physiological or anatomical difference to non-ADHD brains.

I'm sure that not all traumatic brain injuries cause exactly the same symptoms of ADHD or exclusively these symptoms but isn't it possible that in some brain injuries the structures that got damaged are the same as the ones that give rise to symptoms of ADHD (e.g. prefrontal cortex).

Regarding stigma, I do see ADHD as a form of brain damage, or at least as having a brain that is suboptimal compared to that of the norm. Also, if being labelled as "brain damaged" results in stigma and possible discrimination, prejudice or any sort of negative treatment then people with TBI shouldn't have to deal with that stigma either. I mean, I guess, the problem is more then that people stigmatise brain damage rather than ADHD having a stigma because it's associated with brain damage. I'm guessing that's not what you mean but to me it sounds a bit like saying don't die your hair black or get tanned because then you will have to deal with racism....

I agree that we don't know enough about ADHD yet to say what it is or isn't, and that's exactly the reason why I'm uncomfortable with people making associations like the one in the article. It's one of those things that can easily lead to misunderstandings and misinformation.

I don't like looking at ADHD as brain damage. That's from more of a personal feeling than an intellectual reason. I recognize that there are many things that are difficult and/or impossible for me. But I refuse to think of myself as damaged because I feel I have just as many strengths and talents, and that I am different, not lesser. Damage implies that I am less than someone who is NT. I believe I am intelligent, creative, and talented, and I fight hard to keep myself from thinking I am less than that. I know I need to work on being a better spouse and parent, but that does not make me feel flawed.

And you're right, people with TBI should not have to live with the stigma they do. That being said, with the utmost respect, I've already got enough stigma to deal with in my life, and I do NOT want to add that form of discrimination to the list. I don't want to sound dismissive of the stigma, but at the same time I work to reduce stigma, and am loathe to create a situation that might increase it. And yes, I suppose it's similar to situations where people will substitute the word wife for husband in conversation to try to hide the fact that they're gay, or people who live in a body of a gender they don't feel belongs to them because they fear the treatment they'd receive if they lived openly as transgender. That being said, I don't fault anyone who hides their true self sometimes, because there are a lot of people out there who will kick you in the teeth for being open and trusting.

namazu
08-14-15, 11:58 AM
I don't like looking at ADHD as brain damage. That's from more of a personal feeling than an intellectual reason. I recognize that there are many things that are difficult and/or impossible for me. But I refuse to think of myself as damaged because I feel I have just as many strengths and talents, and that I am different, not lesser. Damage implies that I am less than someone who is NT. I believe I am intelligent, creative, and talented, and I fight hard to keep myself from thinking I am less than that. I know I need to work on being a better spouse and parent, but that does not make me feel flawed.

A few thoughts on this...

1) You needn't look at ADHD (in general) as a form of brain damage in order to acknowledge that some kinds of brain damage can produce ADHD symptoms or to acknowledge that people with ADHD and people with TBI often share certain struggles with memory, impulse control, etc.

2) The fact that you have difficulties -- or even that some people have demonstrable brain damage -- doesn't preclude the possibility of having strengths, talents, gifts. It does make the contrast between strengths and weaknesses greater. There's a whole literature on "dual exceptionalities", which has focused on kids with intellectual strengths or other pronounced talents who also have disabilities (often LDs or ADHD, but also other conditions), which you might find interesting (even if it is typically focused on school-age kids). There is cognitive dissonance, for sure.

3) Damage implies that I am less than someone who is NT. Here I'd draw a distinction between damage to a part of your body and damage to your worth as a person. I don't think they're the same. (Yes, there are plenty of people who do see things that way, and even some streams of thought within "bioethics" that accord less value to the life of someone with a disability than without, but...I, for one, am not on board with that. Does a disability have adverse impact on a person's life and functional abilities? Absolutely, by definition. But does it make that life inherently worth less than another's? Not in my book.)

4) You don't need to go around explaining that ADHD and TBI have some links. You don't have to share your diagnosis with anyone. If it works for you, you can try to "pass". But I worry that efforts to erase the stigma of some disabilities by actively dissociating them from other disabilities do so at the expense of people with those other disabilities. (Which, I should add, include many of the members of the forum.)

I guess what I'm saying is, you don't have to go around trumpeting associations with conditions you feel are more stigmatized, or more likely to add to the stigma people with ADHD face. And if in your life, you feel you can live better and contribute more by not labeling yourself, that's fine. But that the same time, please be cautious not to disparage (explicitly or implicitly) "those other people who aren't like [you]".

Lunacie
08-14-15, 12:09 PM
I agree that we don't know enough about ADHD yet to say what it is or isn't, and that's exactly the reason why I'm uncomfortable with people making associations like the one in the article. It's one of those things that can easily lead to misunderstandings and misinformation.

I don't like looking at ADHD as brain damage. That's from more of a personal feeling than an intellectual reason. I recognize that there are many things that are difficult and/or impossible for me. But I refuse to think of myself as damaged because I feel I have just as many strengths and talents, and that I am different, not lesser. Damage implies that I am less than someone who is NT. I believe I am intelligent, creative, and talented, and I fight hard to keep myself from thinking I am less than that. I know I need to work on being a better spouse and parent, but that does not make me feel flawed.

And you're right, people with TBI should not have to live with the stigma they do. That being said, with the utmost respect, I've already got enough stigma to deal with in my life, and I do NOT want to add that form of discrimination to the list. I don't want to sound dismissive of the stigma, but at the same time I work to reduce stigma, and am loathe to create a situation that might increase it. And yes, I suppose it's similar to situations where people will substitute the word wife for husband in conversation to try to hide the fact that they're gay, or people who live in a body of a gender they don't feel belongs to them because they fear the treatment they'd receive if they lived openly as transgender. That being said, I don't fault anyone who hides their true self sometimes, because there are a lot of people out there who will kick you in the teeth for being open and trusting.

I don't consider my brain to be damaged. I believe it is under-developed.

If a photograph has been properly prepared but at a later time someone
accidentally spills coffee on it, then it's damaged.

On the other hand, the photo may have been left in the developing solution
for too short a time, then it's under-developed. It's not damaged.

Fortune
08-14-15, 12:26 PM
I don't like looking at ADHD as brain damage. That's from more of a personal feeling than an intellectual reason. I recognize that there are many things that are difficult and/or impossible for me. But I refuse to think of myself as damaged because I feel I have just as many strengths and talents, and that I am different, not lesser. Damage implies that I am less than someone who is NT. I believe I am intelligent, creative, and talented, and I fight hard to keep myself from thinking I am less than that. I know I need to work on being a better spouse and parent, but that does not make me feel flawed.

I am sure that people who have TBI are thrilled with your solidarity. They're not less than NT either, nor does TBI imply that they are. The idea that someone is lesser because of disability (any disability) is a problem with the way disability is viewed, not the way disabled people are.

KarmanMonkey
08-14-15, 03:29 PM
I have to say I'm putting my foot in my mouth more than usual today. Reading over my post makes it apparent that I still have some stigma of my own to work through...

The people I've met with TBIs I've never considered to be less of a person because of it, but obviously from what I've written there's part of me that still feels that way about the group as a whole.

Thanks for calling me on it!

I think my behaviour toward people with TBIs is better than my writing today would suggest. I hope it is. But obviously I need to figure out where that statement came from and give that part of my brain a swift kick in the ***!

KarmanMonkey
08-14-15, 03:33 PM
And to further the photo analogy, there are plenty of people who see an underdeveloped photo, or one with a coffee ring on it, and see it as less valuable, then there are others who see that sometimes the underdeveloped photo has a different character, and may even tell a different story, and the coffee rings add character and history to the photo.

A lot comes back to the person's perspective. And I'm glad you all called me on it, so now I can pay closer attention and challenge those outdated and biased thoughts/perspectives.

mildadhd
08-15-15, 12:11 AM
There are some people who have been diagnosed with a ADHD that appear to develop.

Do people grow out of ADHD?

Some children grow out of ADHD; others have problems that continue into adolescence and beyond.

Approximately two out of five children with ADHD continue to have difficulties at age 18.

The main symptoms of ADHD, such as attention difficulties, may improve as children get older, but behavioural problems such as disobedience or aggression may become worse if a child does not receive help.

In particular, boys who are hyperactive and aggressive tend to become unpopular with other children.

It is therefore very important for children to receive help as early as possible, to prevent them from getting socially isolated and from developing other emotional and behaviour problems that can persist into adult life.

http://www.mentalhealth.org.uk/help-information/mental-health-a-z/A/attention-deficit/




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mildadhd
08-15-15, 12:56 AM
The critical sensitive period of rapid photo development peaks after about the first year.

Soaking and development time increases dramatically after the first 1 year.

Photos take longer to soak and develop with time, but some photo development is always possible.


P

sarahsweets
08-15-15, 07:04 AM
I'll tell you what I have been sick of lately, this idea that "i have this disorder but its not like I have THAT disorder!"
I experience this with bipolar all the time.
"Omg I am like bipolar today-happy and sad, so moody!"
"Im moody but its not like I am bipolar or anything"
" I mean I take psychiatric meds but its not like if I dont take them Ill go crazy and kill people"
" Its not like I hear voices or something, Im just really worked up"
"wow, what a nutcase, time to call the white coats"
"wow you are off the wall today did you take your meds?"
This whole idea of "qualifying" our disorders while knocking someone down makes me sick, and God forbid someone with a bipolar commits a crime-the media goes f**ing ape sh*t over the bipolar part.

amberwillow
08-16-15, 06:00 AM
My husband has a small damaged area of his brain caused by TBI (on the right temporal lobe), where some other kid lobbed a D-cell battery at his head. He also has a family history of ADHD and has been diagnosed as ADHD-Inattentive... I've found this thread interesting reading.

KarmanMonkey
08-18-15, 03:56 PM
I'll tell you what I have been sick of lately, this idea that "i have this disorder but its not like I have THAT disorder!"
I experience this with bipolar all the time.
"Omg I am like bipolar today-happy and sad, so moody!"
"Im moody but its not like I am bipolar or anything"
" I mean I take psychiatric meds but its not like if I dont take them Ill go crazy and kill people"
" Its not like I hear voices or something, Im just really worked up"
"wow, what a nutcase, time to call the white coats"
"wow you are off the wall today did you take your meds?"
This whole idea of "qualifying" our disorders while knocking someone down makes me sick, and God forbid someone with a bipolar commits a crime-the media goes f**ing ape sh*t over the bipolar part.

I'm glad people pointed that out to me, because I was essentially stigmatizing everyone with TBIs.

My personal philosophy is that a label helps if and only if it leads to solutions for challenges a person is having.

I've been trying to discourage people from using labels in the way you describe. It takes time though. Many of us grew up with that way of talking being commonplace.

In a similar way, since having a mental illness is part of my job description, I'm wondering if any time I have a sick day people assume it's because of the mental illness. Then another part of my brain chimes in and says "Why does it matter? A sick day is a sick day, isn't it?"

I hate it when people without a condition use the label to describe a mundane experience (e.g. "I'm so bipolar today", or "I'm a bit OCD today", or my personal favourite: "I forgot my keys this morning. Maybe I have ADHD"...), as it is so incredibly dismissive of the people who genuinely struggle with those situations. I find this happens with anxiety and depression especially; that the words get used so often that they're watered down beyond all recognition... If someone's idea of depression is feeling a little down when they get dumped, what word do you use to describe what I went through?

I sometimes will address it with humour: "Nah, your ex isn't psychotic; she's just nasty. Personally I'd much rather spend time with someone who's psychotic than mean any day." I like Dave Granirer's take on Stigma:

http://www.youtube.com/watch?v=_TUCjBWV7IA

When someone uses the "did you take your meds" line, I usually counter with something like "this is a situation, not a symptom", "If I was, life would probably be a lot more fun right now", or even "Do you know how disrespectful that statement can be?"

I do feel that a lot of the time we can respectfully call people on their ignorance without causing them to become defensive; and a lot of people use phrases simply because they've been part of our language for years, and nobody has bothered to tell them that it's not okay any more.

I wonder what strategies have been effective in sexism and racism? It's certainly not the same issue, but they are both problems that required us to change our use of language to be more respectful.

With the media, I attended an anti-stigma conference a couple years ago:

For any news story that uses "bipolar" "schizophrenia" or "mental illness" in the headline,

70% are reporting a violent crime,
only 30% of the perpetrators actually had a mental illness, and
only 20% of the articles quoted someone who actually knows anything about mental illness

The truth is that 95% of violent acts are committed by people with no mental illness. The problem is that you never see a headline like:

"Person with high blood pressure commits murder"
"Person with no mental health issue attacks neighbour", or
"Person with bipolar disorder successfully navigates being a single mother, working and volunteering for the local humane society"

Media is at the root of a lot of the misinformation people hold onto. Their only knowledge of what it means to have a mental illness comes from an intensely biased, largely incorrect source. Since it's in a newspaper or on the news, it must be true, right?

To use another example, virtually every school shooting in north America has had a link to violent video games in the early news reports on the subject. Meanwhile, only in four cases of the 20 or so worst ones (as of a few years ago when I did some research on it) did the shooters even own/play video games, and only in two was there any identifiable connection. There have been scholarly articles that have quoted the news reports to make claims that violent video games are responsible... Wait a minute, shouldn't reporting be based on science and fact, and not have science based on pure unfounded speculation? When did this happen to our society?

To counter the school shooting reporting, a Canadian magazine recently published an article that did extensive research in the subject and discovered that violent video games and social media have reduced violent crime in youth by 40% in the last 5 years or so. Go figure.

*sigh* I'd love for our culture to return to a state where the news is at least as interested in facts as they are in ratings.