View Full Version : What is the evidence for ADD and for the effectiveness/safety of meds


Jacksper
09-17-15, 01:46 PM
During the last month a topic that really grabbed my attention (and that of many others here) is that of whether ADD is a disorder or not (here's a link to that thread (http://www.addforums.com/forums/showthread.php?t=171449)). During that month I was leaning towards accepting that it is. I have resisted my ADD diagnosis for a long time and I was kind of tired of always trying to be better, so I felt a need to just let go and accept my limitations. During the last weeks I also used meds, which is another thing I don't really like to do but I felt that it was time to try them.

Well, I don't want to say that I completely changed my mind, but now I just have some doubts in my mind, based on some things I read/podcasts I listened too;

1) why call ADD a disorder (/unhealthy) when the society we live in itself is unhealthy in many ways (wars/poverty/corruption/child abuse/absent parents/broken schooling system/etc)? I see that people with ADD have difficulty with adapting to our society, but is it (always) right to blame people with ADD/mental health issues for that?

2) how is the research with ADD going; is there now physiological evidence for ADD? I am genuinely interested in hearing about this, since I have not heard of any physiological test (for example a brain scan) that has been developed to show whether anyone has ADD or not.

3) I sometimes wonder how powerful the effect of learned helplessness is; I mean how likely is someone to become successful if you tell him/her that (s)he has a mental disorder. This does not mean that ADD is not a thing, but it could make matters worse.

4) Are meds actually safe? I fear that they may mess up my brain chemistry. How thoroughly have they been tested and what has been the outcome?

I am interested in open conversation about this topic, and I am willing to "follow the data", even if the answers are not attractive. I know that this is a controversial topic, but I am sure we can have a rational and polite discussion about this. I am especially interested in hearing about the research/evidence. I will also investigate these questions myself, but I am sure that many of you have looked into these questions before and I wonder what you have found out.

Remember the topic is not about whether your suffering is real, I am sure it is. Living in this world is challenging. So please don't take this topic as a personal attack. I just think it's important to not accept things without evidence, and I have considerably changed many beliefs about the world because I had to follow the data, and I noticed that I did not really have evidence for ADD. This does not mean that there isn't any, but (probably) just that I have not investigated it enough.

Thanks in advance!
J

dvdnvwls
09-17-15, 02:10 PM
One place that can form at least a beginning for you is the work of Russell Barkley. He gives short concise answers to all (or at least most) of this, in Taking Charge of Adult ADHD, a basic easy-reading first book for someone with ADHD who just wants to know the facts. He has also written a number of other things (and recorded videos available on YouTube) that go into more detail on the various topics.

He tends to have a kind of serious, matter-of-fact manner of speaking and writing, which some people find refreshingly straightforward, and which other people find dull and boring. :) But for "Where is the research now, what is the true status of ADHD, are ADHD meds safe, is learned helplessness often a major factor for people with ADHD" - he's pretty much got it covered.

Stevuke79
09-17-15, 03:21 PM
What is the evidence for combustion, and the effectiveness/safety of car engines?
What is the evidence for nutrition, and the evidence/safety of a weight watchers diet?

Fuzzy12
09-17-15, 05:26 PM
1. In my view, definitely a disorder as it's defined by impairments. Again,in my view, I would be impaired in any society I can think of. A lot of the symptoms, like boredom, restlessness, the inability to sustain interest in anything or maintain a constant state of balanced mood, affect me negatively even in the absence of anything that has got to do with other people.

Also, just because something is called a disorder it in no way means that you are assigning blame to the disordered person. In the contrary. Diagnosing someone with cancer or myopia very rarely comes with blame either, isn't it?

2. I am not sure what is the latest research but I remember some studies that showed certain anatomical differences. I don't remember exactly but I think some of the differences included a slightly smaller more frontal cortex and/or less activity in certain parts. I hope someone else can comment on this..I keep.looking this stuff up but I just can't remember.

3. I wonder about learned helplessness as well. I think ADHD symptoms are not the same as learned helplessness but maybe they can lead in some people to feelings of helplessness on top of their symptoms. I often wonder how much of my impairments are just learned helplessness but then I also often wonder if we ve got ADHD at all.

4. Again, I hope someone can comment who can actually both read and remember what they read. From what I remember stimulant meds are comparatively safe when taken as directed and if you don't have any conditions that make meds unsuitable or unsafe for you. I haven't seen much about them messing up brain chemistry though I remember vaguely a study where they said that some stimulants actually have a beneficial effect. Again, apologies, I don't remember the details.

dvdnvwls
09-17-15, 06:04 PM
Disorder does not mean "unhealthy". Disorder means more like "abnormal set of problems to solve or work around".

It has to be "abnormal problem" and not just "problem", because many non-disordered parts of everyone's life are still undeniably a problem. :)

dvdnvwls
09-17-15, 06:25 PM
There is enough literature of a scientific nature to satisfy every question you may have. Barkley cites most of the most important pieces of work, so looking him up is an efficient way of indirectly obtaining a usable bibliography.

Besides the literature, my own personal approach to the evidence for ADHD is something like this:

There exists a large group of people who all share the same set of impairments, or at least each has a significant subset thereof. Not only do these people share the obvious impairments, we also tend to share a long list of seemingly-incidental characteristics and behaviours, similar to the way in which evolutionarily-related animals tend to share not only functional physical features but also non-functional ones (birds having thumb bones in their wings, humans having a tail bone and an appendix, etc). The fact that people with ADHD come from all parts of the world, all cultures, all ages, all skin colours, etc, yet we share not only our major symptoms of impairment but also so many odd and "unnecessary" characteristics - to me, this strange and non-functional aspect of our homogeneity seems to indicate, even more than the official symptoms, that ADHD is "A Thing", and not an invented label for a few symptoms.

Sorry to harp on Barkley, but in the appendix of the book I mentioned before, there's a list of around a hundred characteristics and "quirks" that we tend to share, outside of the official symptoms.

sarahsweets
09-18-15, 08:38 AM
There is antecdotal (sp) evidence that can be found on my sticky in the childrens diagnosis sub forum.

Stevuke79
09-18-15, 04:21 PM
The problem is that a little knowledge is dangerous. Many of your questions have nothing to do with the whether or not ADHD is a disorder.

1) why call ADD a disorder (/unhealthy) when the society we live in itself is unhealthy in many ways (wars/poverty/corruption/child abuse/absent parents/broken schooling system/etc)?

The two things are unrelated. The health of our society has no relation to whether ADHD is a disorder.

Take any disorder and add societal child abuse to the mix, and it's still a disorder.

I see that people with ADD have difficulty with adapting to our society, but is it (always) right to blame people with ADD/mental health issues for that?

ADHD is not defined as a failure to adapt.

2) how is the research with ADD going;
200 years and going strong.

is there now physiological evidence for ADD?
No, and there wont be in the foreseeable future. We don't tend to find or look for physiological markers for ADHD. This is so for nearly all neurological disorders.

Asking about phisiological markers within the context of neurological disorders isn't really relevant unless your point is that ALL neurological disorders are not valid. However, if you are discussing ADHD specifically but do not also invalidate all other disorders, then you are selectively applying that criteria.

3) I sometimes wonder how powerful the effect of learned helplessness is; I mean how likely is someone to become successful if you tell him/her that (s)he has a mental disorder. This does not mean that ADD is not a thing, but it could make matters worse.
Secondary benefits are a clinical fact. There are secondary benefits to ADHD, as there are for all illnesses.

Secondary benefits are interesting and very important but have nothing to do with the validity of any disorder or the validity of ADHD. If the existence of secondary benefits made a disorder or illness invalid, then ALL illnesses would be invalid.

4) Are meds actually safe? I fear that they may mess up my brain chemistry. How thoroughly have they been tested and what has been the outcome?
We've been using stimulant medication since the 1930's. I direct you to pubmed and ncbi.org for answers to any questions you may have about ADHD meds.

I don't care to look for it, but in my posts here somewhere I cite a favorite study that considers the neuroadaptive effects of stimulant meds. The study concludes that with ADHD no statistically significant long term effects are found.


HOWEVER.. people can always make plenty of money fear mongering and writing books that ask irrelevant questions.. because unfortunately most people don't know how to identify a fallacy when they see one..

ADaptHD
09-19-15, 03:12 AM
1. Societal problems probably exacerbate some of the struggles people with ADHD face. For example, if the education system was less dysfunctional and more willing to take into account the fact that people learn in different ways, ADHD students would have an easier time. However, that doesn't mean ADHD wouldn't exist even in a utopian society either.

This is such a big question that in the end I think it's one where you might just have to listen to your personal experience -- personally, I know that some environments clash more with my ADHD than others, but I've never found an environment where my symptoms (or traits if you're looking at it that way) vanish completely.

2. The situation with ADHD research isn't really special -- it's basically the same as with research into all neuropsychiatric disorders. Take schizophrenia. Researchers find certain patterns and characteristic changes in the brains of people with schizophrenia, but at this stage they simply don't know enough about how the brain works in general to know for sure what these patterns mean in a wider context or to make them the basis of a biological "test" for schizophrenia.

There are a lot of measurable differences between the brains of ADHDers and the brains of NTs, but different researchers have different perspectives on what these differences mean. One interpretation that's been growing in popularity is the idea that people with ADHD have brains where the different regions are essentially connected differently -- eg. see https://www.cofo.edu/Page/Students/Work-Education.96.html

Also complicating this is the possibility that there are several different flavors of ADHD that look similar from the outside but actually have different neural underpinnings.

3. I think it's definitely true that beyond the primary symptoms of ADHD people often develop secondary problems like anxiety, depression, etc. as a result of dealing with ADHD. This is one area where social context really does make a difference -- changing society wouldn't necessarily make ADHD non-impairing, but it could make it less likely for people to develop these secondary problems as a result of struggling with ADHD.

4. Well, how strong the evidence is on this depends partly on what you mean by "safe" and "mess up." Stimulants have been around long enough that we can be pretty sure they aren't associated with any major risks. On the other hand, it's also impossible to say for sure that there aren't more subtle changes in brain chemistry associated with long-term stimulant use -- but if you have a certain level of impairment, it seems like the benefits of stimulant use outweigh any of these potential more subtle effects.

It's worth keeping in mind that stimulants do by definition alter your brain chemistry. That's the point. There's at least one study (http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2008.08050781) that's found that they impact brain development, but that study actually found that they seem to normalize brain development. So it's possible there are some less obvious long-term effects in adults that just haven't been researched yet, but it's also true that changing your brain chemistry isn't necessarily a bad thing.

There are a lot of trade books written by people who have different takes on this, but if you want to get a really balanced view and actually see the hard evidence you should just head over to Google Scholar. In the big picture, the way I see it is that there are a lot of questions that are just too complex to answer with our incomplete understanding of how the brain works, but the gist of things seems to be that ADHD comes with serious impairments that can be at least partly relieved with stimulants.