I have a question about Barkley's view on Inattentive. First a quote from Barkley:




From Dr. Russell Barkley San Fan lecture 2000

"Now I want to come back to this group that we call Inattentive AD/HD. We used to call them ADD without Hyperactivity. These days some people are just using the term ADD for them. I don’t like that. Part of the problem with using that term is that that was the old term for AD/HD over 10 years ago, so it creates a lot of labeling confusion.

"ADD and AD/HD are the same thing. ADD is the earlier, 1987 term-goes all the way back to 1980, in fact, whereas AD/HD is the more recent label.

"So let’s talk about this Inattentive type: the kids who come to see us who don’t show problems with hyperactivity, who aren’t impulsive. What do we know about that subtype? We know enough that several of us in the research community have taken to arguing that this is a different disorder. This does not belong in AD/HD. This is not AD/HD. This is a real attention disorder with real information processing deficits, and it has little in common with the other two kinds of AD/HD.

"The Hyperactive type of AD/HD and the Combined type of AD/HD are the same disorder. You’re just catching it at different developmental stages. Kids start out with Hyperactivity; the attention deficits come within a few years after that, and then they move into being the Combined type. But these children, on the other hand, are a different story all together. Why do I think this is a different disorder? Why do some of my colleagues agree with it? Why do the rest of my scientific colleagues certainly agree that this is a qualitatively different group of children? Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way.

"But we will not know any more about treatment if we don’t view them differently, because everyone will assume as you may do, quite naively, that the treatments for one apply to all the subtypes, and they don’t. We have discovered a new disorder and it does not belong here. It needs its own name and its own criteria and it needs to get out of this category known as the disruptive behavior disorders, because it has no affinity for them. So let me show you why many of my colleagues are now slowly coming around to an idea that 10 years ago I argued for. This is a different disorder. Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractable, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention.

"Other things we see in these children: when we bring them into the clinic, and we run them through a battery of neuropsychological tests, they have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. AD/HD children have no trouble with selective attention. And by the way, let’s put an end then, to this metaphor for AD/HD that it’s a filtering problem. Because it isn’t. Real AD/HD has no trouble with filtering, selecting information. AD/HD children perceive the world exactly as everybody else does. These children don’t. These kids have a selective attention problem, which by the way explains something that we have found in about six different studies. These kids make more mistakes in academic work than AD/HD children do, many more mistakes. The problem that AD/HD children have is with productivity; number of problems attempted. The problem with these kids is accuracy: the number of errors made. These kids have a real problem with input coming into the brain, how quickly they can handle it, how accurately they can select it out, and deal with it. These children have memory problems. AD/HD children do not. These children have trouble with getting information out of short-term and longterm memory and doing it correctly. It’s especially so for long-term memory, so that they show a very erratic recall of information. AD/HD children, if they have a memory problem, it’s going to be in a very unusual form of memory we’re going to talk about later today. But this is traditional long-term storage, and these children have some trouble with that, probably for the same reason. They’re not getting information out of memory any more accurately than they’re processing information coming into the brain.

"There are problems with selection, with filtering, with focusing their attention. These children have a very different social profile. The traditional AD/HD child is often a rejected child, because they’re immature and emotional and hotheaded and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the AD/HD children they often wind up as being the least liked, the least popular and most likely to fight. That is their peer group profile. That is what Ken Dodge and his profile of peer acceptance views as the rejected child. And 50 percent or more of AD/HD children are utterly rejected by their peer group; these [inattentive] children, very different picture. These children are overlooked. In Ken Dodge’s taxonomy of social problems, they’re neglected. Why? Because they’re passive, uninvolved. They’re staring, daydreaming, hypoactive, absent-minded, passive. Unengaged is a better term for them. They’re not disliked by the other kids. They’re not rejected by them. The other kids just don’t know them. They’re not engaging. They’re not out there participating. They’re just kind of passive kids. They have more friends than AD/HD children have, actually. These kids tend to be neglected, not rejected. It’s a very different social profile.

"Other differences: there is no affinity of this disorder for Oppositional (Defiant) or Conduct Disorder that we can tell. They basically have the same base rates as the normal population. But many AD/HD children are likely to go on to develop Oppositional Disorder and Conduct Disorder. Forty-five to 55 percent of AD/HD children develop Oppositional Disorder by age 7, and another 25-45 percent move up to Conduct Disorder by ages 8 to 12. AD/HD goes with Oppositional and Conduct Disorder. The inattentive group does not.

"You see another reason why they don’t belong in this group? Those three disorders-AD/HD, ODD, and CD-are all part of a larger category we call the disruptive disorders. The inattentive group isn’t and it shouldn’t be there. Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know.

"[At this time] there are no other studies of treatment of this group-none. The only studies are five involving medication and mine was the only one that tested multiple doses with a placebo control. There are only two pages in my parents’ book, Taking Charge of ADHD, on this group, and it tells you what I just told you. This is what we know. These are different kids. This is a different disorder. Stay tuned. We don’t know what to do with them. It’s up to you. You’re just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you."

"They may have different causes. They certainly have different family histories. Those children tend to come from families where there are more anxiety disorders and learning disabilities. AD/HD children come from families where there’s more AD/HD, Conduct Disorder, antisocial behavior, and substance abuse. The family histories of these two groups are not the same. Now, we have to be careful here, because the Inattentive group, it turns out, is rather a wastebasket group of kids. First of all, in that group are the true Inattentive kids. But also in that group are AD/HD children who came in one symptom short of being in the Combined group, right? They’ve got six inattention and five hyperactive symptoms, and according to the DSM, if they don’t have six, they’re not in the Combined type. Well, yes they are, and you should think of them as being Combined type children, even if they come up one symptom short. Don’t put those kids into the Inattentive group.

"The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.

"So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid, and it shouldn’t matter what the DSM is telling you about cut-off scores. Clinically that’s how you would approach that child. That’s a Combined type kid. And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive, slow-moving group. And as long as you conceptualize them that way, you won’t make any clinical mistakes. But if you follow the DSM as it’s written-perhaps you have OCD and you just have to follow all those criteria, just as they’re written-then you’re going to get yourself into some trouble.

"And by the way, I said the Inattentive group was a wastebasket. Why did I say that? Inattention is nonspecific. Inattention is unhelpful in defining what disorder you have, because most mental disorders produce inattention. So if somebody walks into your clinic and says, you know, I’m having a lot of trouble concentrating, can’t pay attention, can’t finish work, you have no idea what they have. You don’t automatically say, oh, that’s AD/HD, I’ve heard about that. This could be a psychotic. This person could be a substance abuser. This person could have a generalized anxiety disorder or panic attacks or major depression or bipolar illness. How the hell do you know what they have? For now, just know that the Inattentive type of AD/HD is a real wastebasket category of really inattentive children, along with children who have other disorders that are producing their inattention. There really is an Inattentive group out there, but they have a different disorder, and it’s not AD/HD."

Here's my question : Given the above quote, are all Inattentive ADD diagnoses "invalid"? And if so, should everyone diagnosed as Inatttentive who has not a "whiff" of impulsivity get reevaluated?

Is that what Barkley intended to imply?

Thanks.

DBR

I think that since there currently *isn't* another category that Innatentive AD/HD types fall into, getting re-evaluated isn't really an option. It might be though, in the future.

I see this as a cautionary tale to professionals who are diagnosing patients to make sure that the AD/HD diagnosis fits. To make sure there isn't something else going on that could cause the innatentive symptoms.

Here's a good thread that discusses the Barkley's SCT (slow cognitive tempo) theory .... http://www.addforums.com/forums/showthread.php?t=19889. SCT would be for those individuals who don't "show a whiff" of impulsivity and therefore aren't combined types, yet, innatentive symptoms aren't due to anxiety, depression, etc.

It's very confusing to try to figure out what all this means to us personally, the folks whose main struggle is innattention. I think it's too early to tell what this all means for us. I think it also underscores the importance of finding a health care professional who is on top of the most current research.

Good luck!

Wheezie

That was very well said.

I agree.

Thanks.

Here's my question : Given the above quote, are all Inattentive ADD diagnoses "invalid"? And if so, should everyone diagnosed as Inatttentive who has not a "whiff" of impulsivity get reevaluated?
No. If your doctor is using the DSM-IV, you will still come up Inattentive.

Think of Barkley as someone on the leading edge who is advocating a certain way redefining the ADHD + SCT diagnostic criteria. His ideas aren't official (at least not yet).

Until they are, we should probably continue to use the DSM standard definitions. If you are inattentive and the standard ADHD treatments aren't helping, you might want to look into SCT if you find it helpful to your predicament. But I think the average ADHDer should ignore Barkley's ideas on this until they become more official.

Russ was on the committee that drew up the DSM-IV criteria.

He wouldn't do that.

Please don't "put the cart before the horse" here.

In my practice for example, which is 90-95% ADHD kids between 6-19/20, I have no intention of changing anything; unless and until its shown to be "evidenced based (supportive by research)."

Please don't worry about something that hasn't happened yet.:)

This discussion keeps coming up. What can we do to keep it from confusing newbies while not resorting to limiting the discussion of the topic?

Should we insist that anyone using Barkley's definitions of the subtypes prefix them like "Barkley Combined" to make it clear it's not quite the same as "DSM Combined"?

Should the discussions be barred from the "General" forums, and instead be placed in the research ones?

Any other ideas?

This discussion keeps coming up. What can we do to keep it from confusing newbies while not resorting to limiting the discussion of the topic?

it's the question of the day, UnleashTheHounds! :)

personally, i think that what you're doing to make sure that these conversations include the proper context is the best solution we have.

it's good to keep in mind that anyone reading these threads can always post questions if something is unclear. personal empowerment, it's a good thing. :D

i understand from reading your other posts how this topic caused you some confusion and angst. however, in the end, you sorted it out. that's the main thing, i think. giving folks the info. the need to find the answers for themselves. like you did. :)

personally, i noted that the Barkley quote was from a lecture that was given 5 years ago. i wonder what's been happening since then and what Barkley's *current* views might be.

but, i digress ... it's what i do best, actually ... :rolleyes:

cheers,

w.

I appreciate all the comments. My Dr indicated to me that I have Inattentive ADD, and, I also have OCD. So he knows what I know--that I'm obsessing over the ADD diagnosis because I'm taking Adderall.

After all, if Inattentive ADD turns out to be bogus, then I'm taking Adderall "under false pretenses."

On the other hand, I cannot deny that I feel better on Adderall than before i started it. I seem to be one of those ADDers who seems to need a stimulant. Of course, the anti-med folks will immediately say "oh, that guy just wants to get high." Not true. I asked my Doc to confirm my ADD diagnosis before I let him prescribe the stimulants.

I know Barkley is a leading light in the ADD professional community. But I can't fathom my Dr. saying he was wrong about my having ADD just because Barkley raises some questions.

And I write all of this with all due respect to Barkley and all others concerned.

Sincerely,

DBR

Barkley simply is stating what Dr.'s should do in the present moment. That is, how they should diagnosis new cases today. If you have never had any hyperactivity you would be inattentive. If you were hyper at 5 years old then you would be ADHD hyperactive or ADHD combo, depending on if you were still displaying hyperactive symptoms. In all three cases you have ADHD. Stimulants help all three catagories....although the clinical success rate percentages, are down a fair bit for the inattentive subtype.

So...don't worry, no one is going to take your ADHD label away from you.:) for a long time...and if they do, way in the future, they will give you a brand new kick as# label. :D Personally, when the time comes, I am looking forward to that new label. :) That is, if we are deserving of a new label...time will tell...

I appreciate all the comments. My Dr indicated to me that I have Inattentive ADD, and, I also have OCD. So he knows what I know--that I'm obsessing over the ADD diagnosis because I'm taking Adderall.

After all, if Inattentive ADD turns out to be bogus, then I'm taking Adderall "under false pretenses."
Is the Adderall working for you? If so, probably no need to obsess about it. Inattentive-ADD will never turn out to be bogus. If Barkley gets his way, the Inattentive group would be divided up, some being reclassified under a different ADHD-subtype and the rest being SCT.

I know Barkley is a leading light in the ADD professional community. But I can't fathom my Dr. saying he was wrong about my having ADD just because Barkley raises some questions.
Thing to keep in mind is just because Barkley says something doesn't automatically make it so, it needs to be peer-reviewed and go through committees and be officially adopted and what not. I know some people like to spread Barkley's words as though they are gospel, but they aren't. Most ADHDer's should ignore Barkley unless they have an interest in advanced research.

My personal opinion is to stick to the accepted standards of practice (current DSM criteria) because its evidenced based (research supported).

I do think prefacing remarks about SCT by saying it's just a theory, would be very helpful.

I don't believe Russ wants people to be confused about his research.

Please try and keep in mind exactly who the target audience is he's speaking to,i.e., who the CEU courses are aimed at.

Are they for parents or clinicians?

Is he discussing research and does he preface his comments in such a way that the AUDIENCE can tell ?

The caveat here would again be who's in the audience and what the topic was or who invited him ,etc.

Forum members are very bright and articulate. We like to discuss things from all angles/points of view.

Sometimes in the process, the topic can take on a "life of it's own" and we lose track of the original premise.

I hate to make this comparison, because Russ's work is so meticulous and has been replicated over the years and found to be valid & reliable, but the analogy would be like discussing Amen's own unique nomenclature as tho it were the accepted standard of practice;which it isn't.

The obvious difference here is that Russ's work has consistently been of the highest quality, while no one except Amen or his student's, protege's, ect., has ever been able to successfully replicate his work.

Posting disclaimers is always the quickest and easiest way .

It's like when I dont know exactly what journal, page #,etc.,is involved in a certain reference, or when I'm saying something anecdotal as opposed to evidenced based, I try to always make that clear.

Thanks for the replies.

Let me say this about Russ, as much as I respect him , I certainly don't agree with everything he says.

That's ridiculous.

The whole notion of getting sidetracked by SCT right now has NOTHING to do with his credibility.

SCT isnt supposed to be approached like it's been substantiated(unless it has and I don't know yet).

People are confusing the hell out of things and overcomplicating matters.

One last thing: I have NEVER in my life seen as serious and dedicated researcher as Russ.

He literally wont say something's evidenced based unless he can back it up.

DBR2,

Whether the name of inattentive is eventually changed or isn't doesn't make your current diagnosis less real or your current medication regime. You're not taking meds under false pretenses if you've been appropriately diagnosed. It sounds like the meds are working well for you -- so don't sweat it.

When I was a kid (a zillion or so years ago) I was diagnosed as hyperactive. If I'd been diagnosed a few years later I would have had Minimal Brain Dysfunction, than ADD with hyperactivity, and finally ADHD. Changing the name doesn't change the syndrome or the medication used to treat it. SSRI's like Prozac were first marketed for depressed but were found to work well for anxiety too (and sometimes even ADHD symptoms:p ) -- what works is what works -- don't get too hung up on a label.

As much as I respect Russell Barkley, he isn't the only researcher out there. In Thomas Brown's new book Attention Deficit Disorder: The Unfocused Mind in Children and Adults he respectfully disagrees with Barkley's seperating Inattentive from the ADD family and gives a very convincing arguement for his reasons for disagreeing.

Incidentally, on the back of Brown's book is a nice recommendation from Barkley stating: "This fine book is a fine book with clinical anecdotes that provide great insight into ADD/ADHD. It demonstrates why ADHD is a far more profound disorder of cognitive development than many people believe. Dispelling many myths, this books provides scientifically based recommendations for the management of the disorder. Well done and well worth reading." Competent professionals can disagree and still see the value and respect each other's work.

One of the more useful concepts I learned in my counseling program is that the map is not the terrain (sp?). The terms we used to describe this condition are not the actual condition itself -- just useful maps to help us understand it a bit more. Some day as the field of neuropsychology advances more we may have entirely new maps that are even more useful, until then we'll do the best with what we have.

Scattered

My 2 bucks:

Barkley is a clinical research psychologist. The majority of his ideas concerning ADHD at this point are hypotheses, they're speculations. They are not considered "facts" because the research has not yet supported his conclusions. However, he is conducting this research. He is involved. That implies he is familiar with what he's talking about. The Inattentive split from ADHD has ups and downs, and pros and cons, but to date, it has not be validated. Until it is (and that won't be for another few years) there's no need to worry about it.

On those pros and cons...ADHD Inattentive is a hard thing to work with. The symptoms of ADHD Inattentive Type are also listed as the symptoms of practically every thought disorder, and they are also often demonstrated not as symptoms but as results of other disorders. It's a very tough thing to work with. ADHD-Inattentive shouldn't, in my opinion, be diagnosed at all unless it is demonstrated that there is absolutely nothing else wrong whatsoever with the individual.

It's important to see what I did there, with "in my opinion." I'm not a doctor yet, I'm not going to be for a few years, but my opinion is worth as much as Dr. Barkley's. Neither of us have research to support our conclusions, so they're opinions. Both are based on our personal study, though I would grant his experience outweighs mine.

At any rate...ADHD-PI does appear to be something different...it doesn't follow the dopamine-regulation problem theory of ADHD-C and ADHD-HI. There's no hyperactivity and no impulsivity. Further, clinical tests of Strattera and other SNRIs seem to show that they work very well with the ADHD-PI population, and not so well with the rest of ADHD. The reason it's marketted as "for Adult ADD" is partly because "Adult ADD" typically doesn't have impulsivity/hyperactivity as much. People with hyperactivity and impulsivity are more likely to have been diagnosed as children, and for this reason Strattera can't market to them as directly.

Conversely, ADHD-C and -HI respond very well to stimulants...ADHD-PI responds virtually the same as anyone who takes a stimulant...there is no paradoxical effect (that I know of) in ADHD-PI. (Again, there's that "I" word. I'm not sure if any research has been done on paradoxical effect in ADHD-PI populations. I don't know of any, so it's possible the research has been done, if it hasn't, then what I just said is still just an opinion, however educated).

I would just like to say that "the map is not the terrain" is among the most important lessons to learn in psychology. We use symptomology to describe conditions, not so we know everything about them, but so that practitioners can communicate effectively, and treatments can be standardized, and research can be done on conditions. Without labels, everyone is a case study. It's possible to work that way. You can completely ignore diagnostic labels and treat individuals exactly as they're presented. Some therapists do that. It's not good practice, though, because you take a lot more notes than necessary, and when that patient moves on, you have to send a book to the new practitioner, instead of a piece of paper.

A transfer sheet using labels could say "ADHD-C, tends to do this, tends to do that, tends to have these things," without labels you have to say "inattentive in this that and the other, tends to do this hyperactive thing, tends to be impulsive with this that and the other" and all you're doing is listing symptoms of a diagnostic label that the other practitioner will slap on there for ease of communication as soon as they get the paperwork.

Labels are not disorders, disorders are not labels. Labels describe disorders, disorders exist regardless of labels. The number of disorders that exist in the world are both limited and unlimited. Only a certain number of things can go wrong, though that number is huge, and because of genetics, disorders cluster and statistically there are a bunch of things that we see go wrong in a similar way in a bunch of different people, and we just take that bunch of wrong-gone things and name it a disorder, to classify it better. Sometimes, people have something that's never even been heard of before, and there's no label that can be used, but at this point, that's very rare.

Regardless, changing the label only changes the communication, it doesn't make an ADHD-PI diagnosis invalid. It just makes the valid ADHD-PI diagnosis into a valid SCT or whatever else diagnosis. When I was diagnosed ADD as a kid, then diagnosed ADHD later, it didn't make the ADD diagnosis bad, it just made it into a good ADHD diagnosis. The criteria stayed virtually the same, the name just changed.

I think an important thing for people with the disorder is to let the scientists and doctors bicker amongst themselves. You should focus on improving the quality of your life, and being happier, and whatever else. The doctors will focus on that too, but have a lot of extra BS politicking and science to deal with. That's not your job. Your job is to 'get better' to use a cliche. Let the doctors and the clinicians figure out what it is you're getting better from.

In some cases, you have to get involved, because the clinicians and doctors don't know what's up...but generally they know when something big changes...they know what they're doing because they have to keep up to date...BUT if they don't know Barkley's new theories, they are still up to date, because Barkley is speculating. When Barkley publishes a new finding in Journal of Clinical Psychology or something like this, they'll need to know that, but as long as Barkley's just writing a freelance novel or giving talks about things he suspects are true, the doctor is just as up to date having never heard it. Nothing has changed yet.

And since I have a penchant for being a schmuck and speaking my mind, I'll say now that I do get annoyed when people say "my psychiatrist doesn't know what's up he diagnosed me as ______ when obviously it's ______ and I know because I read this book by such and such that's primarily their own personal opinions." "He didn't diagnose ADHD right he didn't use the method Barkley talked about in his lecture series on his personal opinions" ...Barkley is making guesses right now, he's making hypotheses, and his research may substantiate it in the future, but until it does, the current accepted practices stand, no matter what anyone suspects. That's not towards anyone in particular, and I'm sure I'll get a bunch of people mad and they'll justify themselves somehow, but since I'm not talking about anyone in particular that'd just be silly, please don't get offended at my saying that, because most people here on these forums do understand what's up.

All vented out, sorry that turned into a ramble...heh

The only theoretical construct/hypothesis I know of regarding Russ is SCT.

Everything else, is rock solid/evidenced based; meaning there's valid & reliable longitudinal research to back it up.

One of the things that originally impressed me was that both Russ & Sam Goldstein, independently arrived at the same point in terms of ADHD being a "disorder of self-regulation."

Russ is a board certified neuropsychologist. He teaches at the Medical College of South Carolina in Charleston.

Prior to that he taught at a medical college in Mass.

He does maintain a clinical practice, as well.

Primarily though, he is viewed as a scientist within the clinical communtiy.

I hope that these responses will allay your fears.

I'm sure he wouldn't want people to be upset over something like this.

Once again, it all comes down to the data.He'll either substantiate it or not.

In the meantime, no one I know of is getting sidetracked on this at all.

If it happens, it happens. Research isn't personal. When data change, then you have to change with it.

Back to Basic Science 101 -- you have to start with a theory and then prove it true or false. Researchers have to develop theories that appear to explain what they are observing before they can test them. From what I've read, Barkley has been pretty clear in qualifying his statements that not all the facts are in and that this "may" be a seperate disorder. Got to start somewhere. I'm with Keith, while it's very interesting to peek in on the goings on in the research community, it's nothing to get bent out of shape about -- let them wrestle with the research, politics, and other researchers. If you're ADD/ADHD/SCT or whatever, you've already got your hands full figuring out your own life. (Well, I do in any case!:p ).

Interesting discussion in anycase, I learned a few new interesting things from you, Keith, in your discussion, so thank you very much.:D

Scattered

With the current exception of the "still in the works SCT", Russ's theories on ADHD have been ALL substantiated.

The majority of the mainstream accepted standard for the science and practice of ADHD, has come from a number of well respected researchers and he's at the top of the list.

I don't know where you're ( collectively) coming up with some of the stuff I'm reading, but a lot of it is simply not true.

His Milwaukee Study that was begun in 1977 is still the longest running ADHD research study in the world.

SCT aside, his work has been substantiated. How do you think researchers develop their reputations?

He is also the last person who would go with suppositons only.

Thanks for your responses. For the record, my questions have been answered.

BTW, while my Dr indicated that Inattentive is what he sees, he did not go into particulars concerning the subtypes--he simply said I have ADD. But when I told him I had taken Dr. Daniel Amen's online questionnaires, he told me he sometimes uses those as a tool for diagnosis, and asked me if I had scored "highly probable" on Inattentive--and I had.

But I also scored "highly probable" for one or two of Amen's other subtypes. I don't recall which ones, inasmuch as what was significant to me was the ADD diagnosis and my DRs statement that he is willing to put it in writing. I realize not everyone is an Amen disciple, but maybe my ADD fits into a combo category.

Anyway, again, my questions about Barkley have been answered and I thank you.

DBR

I mentioned this earlier, but Amen's "types" are a perfect example of unsubstantiated theoretical constructs.

Unlike Barkley, Amen's work has not been able to be reproduced by any other researchers; save his student's, associates, etc.

As far as Russ's books are concerned, he is always careful about delineating unproven theory/speculation from evidenced based (substantiated) research.

Amen, on the other hand, has charged ahead and written as though his results are a "given."

They are far from it. Personally, I find his work to hold the potential for confusion, as no one clinically recognizes the "RIng of Fire" as a valid type of ADHD.

Barkley's ideas on how to reorganize the ADHD subtypes are a bit arbitrary. I mean, instead of making ADHD-I purely SCT, and making everyone else who used to be ADHD-I who're not SCT ADHD-C, he could invent different labels. So it's not his research I have an issue with, it's his relabelling. And it's not really Barkley I have an issue with as his admirers who insist that Barkleys new labels should be used as the norm.

So it becomes a problem when they discuss the subject with the rest of us who are using the DSM labels. We use the same labels "combined, inattentive", but they mean DIFFERENT things . So it creates alot of confusion, and leads to alot of threads like these where people are worried about being misdiagnosed or what not.

At least with Amen, if someone says they are the "ring of fire" type, we instantly know whose terminology they are using.

You may know what it means, but there's no research to validate its real.

There's only a problem with nomenclature if you allow yourself to become sidetracked.

I still say this is putting the cart before the horse and (over) complicating something that hasn't fully developled yet.

He's speculating.He doenst make the rules.

Personally, I'm tired of the confusion .

P.S.

Amen was the least bit subtle in rolling out his new book. A newbie could easily believe that was the accepted standard, when it isn't.

Wait and see what happens.

I'd like to clarify some of my statements before...I did specify that there are things in Barkley's books that are substantiated, all of his books are not entirely unsubstantiated, that would be mispeaking. If I did give that impression, I apologize. I was speaking specifically of Barkley's (and other's) ideation that ADHD-PI is not actually related to ADHD. While it appears to be a well founded hypothesis, the research does not yet substantiate this separation. That was the only thing (in this particular context) that I was saying is unsubstantiated. I have no reason to criticize Dr. Barkley or his research, and I did not mean to say he is not an authority on the subject...it is simply important to remember that being an authority on a subject does not make your speculations about that subject automatically correct. Until validated, SCT and other hypotheses are not considered normative.

As far as Dr. Amen...I said from the very beginning that I don't trust him or his work, as what he's released is not scientifically sound, and his alledged "evidence" is withheld. I've said that since his book was popular a year ago and I continue to say it. I am glad my skepticism of his work proved fruitful, but it is important to approach all things with a healthy level of skepticism.

I don't know where you're ( collectively) coming up with some of the stuff I'm reading, but a lot of it is simply not true.
McTavish, if I was one of the posts you were responding too here, I was in no way trying to detract from Barkley's work or professionalism -- quite the opposite actually. I was just trying to point out that he is following standard research practice and also that he is very clear in his writing when he is giving well documented facts or working with well educated theories based on his experience and research with ADHD.
With the current exception of the "still in the works SCT", Russ's theories on ADHD have been ALL substantiated.I'm wondering if this statement is accurate because in his book for parents on managing ADHD he discusses the concept of self-talk and very clearly explains that this is a theory he is working on but that he doesn't yet have all the facts. This is actually one I wonder about more than any other, so I'll probably start a new thread and see what anyone else experiences, but I have way more self talk than I find useful.

The majority of the mainstream accepted standard for the science and practice of ADHD, has come from a number of well respected researchers and he's at the top of the list.Absolutely true, in case I botched my original message, I was justing trying to say relax and don't worry too much about the labels the scientists are working on developing (my apologies to dbr2 who obviously got his question answered a while back -- these threads do tend to take on a life of their own:rolleyes: ).

Scattered

Scattered,


I stand corrected. Thanks for pointing that out.

There's actually a lot of things that need to be "ironed out," from age referencing the symptoms, to dealing with what best describes what is now referred to as Inattention and Hyperactivity-Impulsivity.

I apologize for the oversight. I got carried away with this whole thread.

The debate on whether ot use Working Memory and Dysinhibition or something simliar continues.

Russ usually comes thru in the end in terms of his specific avenues of research.

At the same time tho, I've also seen him reverse his stance and go with the research when it (research) no longer supports that position.

A good example of this would be his stance on Continuous Performance Tests (CPT's).

Research isn't personal.

Looking for answers and striving to improve matters for the greater good is what's important.


Thanks again.:) Accuracy is (still) everything.

mctavish23 (Robert)

You may know what it means, but there's no research to validate its real.
I'm not saying he's right, but if someone claims to be "Ring of fire" type, then at least the communication is clear. We can tell them "Ring of Fire" isn't widely accepted.

There's only a problem with nomenclature if you allow yourself to become sidetracked.
But if someone claims to be inattentive type, now we have to ask, "is that DSM Inattentive or Barkley Inattentive?" It's the same word with two different possible meanings, and some people here insist on using the Barkley definition without saying they are using the definition.

There's new people arriving here all the time, they may be unaware of the debate, and we should be careful not to confuse them and make them think they've been misdiagnosed.

I still say this is putting the cart before the horse and (over) complicating something that hasn't fully developled yet.

He's speculating.He doenst make the rules.

Personally, I'm tired of the confusion .
I agree. All I'm asking is that if you talk about a Barkley hypothesis/theory that hasn't been officially adopted yet, just make sure you label it as such. I don't know why this debate always turns into a defense of Barkley's credentials, I don't see anyone attacking them.

Someone saying they were Inattentive type wouldnt mean anything more than the current DSM-IV dx of ADHD Predominantly Type.

Why would we (Forum) be confused?

The only confusion is from those who can't see that this is hypothetical.

There's only one ADHD Predominantly Inattentive type.

I'm also frustrated because... NO ONE (professionally)... is referring to a specifc "Barkley Inattentive type."

It doesnt exist.

Barkley hasn't publicized SCT and most people don't know about it.

To see it take on a life of its own is frustrating.

It's NOT meant to be considered as anything more than a theory.

If you were to walk into Barnes & Noble you easily could find Amen's latest book proclaiming his theories.

You have to dig to find Barkley's because, as far as I know, it's not substantiated yet.

Someone saying they were Inattentive type wouldnt mean anything more than the current DSM-IV dx of ADHD Predominantly Type.

Why would we (Forum) be confused?
That's what it should mean, but there have been posts insisting that people who have been diagnosed ADHD predominatly Inattentive should call themselves "combined" if they've ever "had a whiff" of hyperactivity, and the true inattentives are SCT. This is an echo of Barkley's idea, and it was passed off as settled fact (way prematurely).

That's were the confusion is coming from.

There's only one ADHD Predominantly Inattentive type.

I'm also frustrated because... NO ONE (professionally)... is referring to a specifc "Barkley Inattentive type."

It doesnt exist.

Barkley hasn't publicized SCT and most people don't know about it.

To see it take on a life of its own is frustrating.

It's NOT meant to be considered as anything more than a theory.

I agree, but some people here can't see it that way, and that's why I asked that they use "Barkley Inattentive" so they don't continue to confuse people who are Inattentive according to the DSM, which you admit is the one true inattentive.

Okay. I can see and appreciate your efforts.

Thanks.

Someone saying they were Inattentive type wouldn’t mean anything more than the current DSM-IV dx of ADHD Predominantly Type.

Gee some who come here aren’t even officially diagnosis as having ADD.


I agree, but some people here can't see it that way, and that's why I asked that they use "Barkley Inattentive" so they don't continue to confuse people who are Inattentive according to the DSM, which you admit is the one true inattentive.


Hmmmm I think the three sub-types are enough to create debates and confusions.....adding names of doctors would create more debates and confusions. but it still happens....frankly I either relate or don't relate to what the person has to say I don't spend too much time worrying about the fact that my ADHD/impulsive type expresses itself differently than it does in other ADHD/ impulsive who post here. The "labels" don't really do the connecting for me the thoughts written on post do....

When given the combined effect ADHD has with personality, temperament, and past experiences each one of us has our own unique ADD that coincides with our individualism....we have a common ground of living with ADHD but to each one of us that has different meaning on an individual level based on who we are as people.


So put me down as having Tammy's impulsive ADHD.....



Why would we (Forum) be confused?

Here is my perspective in all this....


ADDed confusion has different reasons......confusion happens to all at some time or another....some times it is an initial part of the learning experience for others it is the spring board of reason for increasing our knowledge....although researchers like Barkley should be commended in their ability to offer us ADDers scientific proof that ADD exist...no one body of knowledge nor oceans of research will be of any use to the person who skips over self education. To educate ourselves about how our symptoms affects us as individuals and the loved ones who share our lives.

If I don't bother learning how my symptoms effect my life (and those in my life) so I can implement positive behavior changes and healthy coping methods no amount of research, knowledge, or medications will be able to improve my life......only I can do that!!!!

Isn't really very confusing when ADD education is put into a personal light. Well not to me any way!!! :)

The underying assumption was that the person had already been dx'd with ADHD-PI.

Sorry if that was confusing.

Tammy,

The debate isn't just whether you are this subtype or that subtype. If it were, I couldn't care less. Barkley has another theory that drives his distinctions, namely that the people who have ADHD-I by his definition possibly do not have ADHD at all, they have something else known as SCT, something that there isn't a whole lot known about.

Some people here have passed off Barkley's ideas as settled fact. This has lead people who are ADHD-I, like myself and some others, to question whether we had been misdiagnosed. Worse, we might have something that there isn't much known about, let alone how best to treat. What these people don't say very clearly is that many people who have been diagnosed as Inattentive would be diagnosed as Combined if Barkley's definitions were the norm. Instead, the argument comes off as "If you are ADHD-inattentive, then you really don't have ADHD".

So I'm just arguing for more clarity to prevent new people from being mislead by this in the future.

That was very well stated and makes excellent sense.

I appreciate the feedback.

His Third Edition of The ADHD Handbook is out,or at least is available from Guilford Press.

I'm not sure if that will be settled or not.

I agree, but some people here can't see it that way, and that's why I asked that they use "Barkley Inattentive" so they don't continue to confuse people who are Inattentive according to the DSM, which you admit is the one true inattentive.
Look, we are talking about new Science here. There have been many things learned and there are still things to be learned.


You could make these statements about straight ADHD...in fact many have..., that we shouldn't go labeling people if we don't even truly know what causes it, nor do we have any 100% correct way of effectively getting the diagnosis right. Yes, with ADHD we could stick our heads in the sand and say, "lets just wait until it all gets sorted out".

But...we don't.

Because using knowledge based on Science, and best practices with ADHD, we find that many people can be helped. So we do things to the best of our ability and sometimes we are in the dark. Through experience we learn(best practices) and treatment becomes much more effective. That is the way it is done. To do otherwise is to be a Luddite.



Now, things are not much different with ADHD-inattentive subtype, except that we are at an earlier stage of knowledge. Yet we know a lot already. There is consensus here. Once again Barkley, "Why do the rest of my scientific colleagues certainly agree that this is a qualitatively different group of children? Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids".

The main issue here, is that we recognize this group is different and start to use different best practices for them.

Barkley has stated, and I have made the point many times, that the diagnosis of ADHD inattentive subtype should now be for only the foggy spacy inattentive ADHD. You can get you're knickers in a knot here about the past and who goes where...but that's the way it is and it's that way for a good reason. You will never figure out what are best practices for this group is if we can't even keep this subgroup straight.

So, I'm sorry that you stopped you're medication, that was never my purpose. You should always talk to you're Dr. first before making radical changes. Didn't everyone learn in Internet 101, that no one should treat information on the web as gospel?

On the other hand, that shouldn't mean that we have to stifle all intercourse on new concepts in the field. In fact, that is one the primary reasons I follow this board...to get new perspectives of others across the globe.

Barkley has stated, and I have made the point many times, that the diagnosis of ADHD inattentive subtype should now be for only the foggy spacy inattentive ADHD. You can get you're knickers in a knot here...but that's the way it is and it's that way for a good reason. You will never figure out what are best practices for this group is if we can't even keep this subgroup straight.
Correct me if I'm wrong, but Barkley doesn't have to power to change the diagnostic criteria all by himself. Again, you insist on spreading Barkley's idea as though it is the accepted norm when everything else seems to indicate that it isn't.

I'm no Luddite. I'm glad Barkley is doing his research, but it should be possible for us to discuss that research without using terminology that will confuse people who have never heard of Barkley or this debate.

This is called "best practice"....do you honestly think people are going to wait 20 odd years for the next DSM update to change the way things are done? lol In the mental health field 20 years is eons. To sit on you're hands for 20 years is bad mental health care...as Barkley said, "it's OCD" in nature.

...I am repeating what I heard Barkley state at a conference full of Dr.'s, professionals, and others who diagnosis ADHD. He talks across the globe, he was on the original DSM committee for ADHD and will probably be on the next one. He has also written about this and I have post this info on the board many times.

It's called "best practice" and it is done all the time.

So...the big question:


Do they take into consideration the environment in which the "subtype" is raised or surrounded?

This is why I (even though I don't even think I could play a doctor on TV) fall to "functional types"

ADDers and all humans (in fact all animals) are built out to:

Have impulses (move towards pleasure, run from pain)
Record patterns (Reality Building)
Follow the most succesful observed patterns to meet the impulses that drive them.

There is a type that is ADD like but not ADD...they are actually quite common.
They most likely did not go through "synaptic pruning" in puberty.

But why spend all of this time "classifying"? Does it lead to "new therapies" or is it just a way to find new meds so we can all be the same?

I just do not get it. (actually I do....most researchers are not interested in knowledge or what they can do with it...their primary impulse is to join groups...of other researchers that have common ideas)

It is futile in a sense...

So you are innattentive...what does that mean...how do you learn?
Have you been abused...do you escape into a fantasy world? Are you AS and ADD... There are so many possibilities that only a "functional analysis" has any worth.

We can argue over whether a tomato is a vegetable or a fruit until the cows come home...the question should be "how do we grow the best tomatoes?"

It is futile in a sense...

So you are innattentive...what does that mean...how do you learn?
Have you been abused...do you escape into a fantasy world? Are you AS and ADD... There are so many possibilities that only a "functional analysis" has any worth.

We can argue over whether a tomato is a vegetable or a fruit until the cows come home...the question should be "how do we grow the best tomatoes?"
If the question is whether it's a fruit or vegetable, then I wouldn't care.

But if the question is, is it a tomato or a pepper? Then it's more important because the answer affects the culinary use. "Is it a sweet pepper or a hot pepper?" could also be a very important question, because if the answer is wrong, you could be in for quite a shock :eek:

Basically the debate comes from this set of facts:
1) Barkley observes a class of people current labeled ADHD-inattentive that he argues have SCT, that he says is not a form of ADHD, it's separate. (a pepper, not a tomato)
2) He argues that the Inattentive subtype should be kept pure for the SCT types, and many people currently labeled Inattentive should really be labelled Combined type if they have a little bit of hyperactivity/impulsivity.
3) This is a significant change from the DSM-IV, which requires you to meet 6 items from the impulsive/hyperactive list to be considered "Combined", Barkley argues that you should need significantly fewer than that.
4) The DSM is widely used, an many people are diagnosed as inattentive according to what it says, not what Barkley's powerpoint slides say.
5) Some people, insist on using Barkley's defintions of these subclasses as the norm, and post information that says inattentive=SCT.
6) This causes some people who are new to all this to say, "You mean I'm not a tomato, I'm a pepper?" :eek: "I've been misdiagnosed?" Upon reading what Barkley actually says, then I find out that I might fall into his redefined combine group, and am still a tomato after all.

Why does it matter? Well it's the difference between having a condition that is fairly well known, with a good body of knowledge on how to cope with and treat, vs. a pretty new condition with very little information about widely available. I come here to learn how to better deal with my ADHD. If I come here and am mistakenly lead to believe that I really don't have ADHD, then it's doing more harm than good, IMO

So in essence, the only reason I care about the label is because of this potential trap for new people, I fell into it, some messages I read seems to indicate others did as well. I care about communication clarity.

Call them labels or diagnoses, insurance companies and the DEA look at them.

And this type of debate might just be the type that the antimed people seize upon to try to fuel their cause.

I once read about a guy who was drinking sixty cups of coffee to calm down. He was then diagnosed wth ADD. He needed Adderall or Ritalin.Today I took Adderall and was still drinking coffee this afternoon.

Call it SCT, Inattentive or unknown factor x, but some of us benefit from stimulants. If Tom Cruse were alone it would be different, but he is just one of many do-gooders who show no real undrstanding of ADD.

DBR

This is called "best practice"....do you honestly think people are going to wait 20 odd years for the next DSM update to change the way things are done? lol In the mental health field 20 years is eons. To sit on you're hands for 20 years is bad mental health care...as Barkley said, "it's OCD" in nature.
Yes.

Do you really think that every mental health professional is attending Barkley's lectures and is agreeing to scrap the DSM guidelines in favor of Barkley's ideas? Not from what I've seen. If you look for information on "Combined" or "Inattentive", it almost always points back to the DSM guidelines.

...I am repeating what I heard Barkley state at a conference full of Dr.'s, professionals, and others who diagnosis ADHD. He talks across the globe, he was on the original DSM committee for ADHD and will probably be on the next one. He has also written about this and I have post this info on the board many times.

It's called "best practice" and it is done all the time.
Scrapping the subgroups used in widely-used, widely published diagnostic criteria and relying on notes taken at a lecture that redefines those subgroups (same name, new meaning) is hardly "best practice".

After all these labels are fairly arbitrary, not dictated by science. Barkley could easily leave the three groups intact and create a fourth group exclusively for his SCT people. It would be less prone to confusion.

One possible hypothesis, if primarily inattentive patients do not experience the same effects from stimulants, is that the disorder could still be related, but that unlike combined or hyperactive types, the exact cause of a lack of prefrontal catecholamines could be different.

What I'm thinking is that it could be possible that combined or hyperactive disorders are caused by excess catecholamine reuptake sites, as we know, but that for some inattentive patients, the problem might be damaged dopaminergic neurons themselves, which would explain why their inattention doesn't lead to hyperactivity, and why stimulants actually stimulate them.

That being said, I do have to question whether this applies to all inattentive patients, or whether what we're really talking about is a small subset of inattentive patients. I would still maintain that all forms of ADD have similar causes and are related, and that making these distinctions is pointless. That being said, if some of the "spacey" patients aren't responding to stimulants and seem to be somewhat different in symptoms and causes from the majority of ADD patients, then it is certainly worth examining possible hypotheses. As McT has pointed out, however, we must not forget that they are simply hypotheses, even my neurological explanation above is pure hypothesis.

If the question is whether it's a fruit or vegetable, then I wouldn't care.

But if the question is, is it a tomato or a pepper? Then it's more important because the answer affects the culinary use. "Is it a sweet pepper or a hot pepper?" could also be a very important question, because if the answer is wrong, you could be in for quite a shock :eek:
Well...of course, but they do not know whether it is a tomato or a pepper in the first place. There is much more time spent classifying then doing "functional analysis".

If they would look at it functionally, they would realize how it works.

an example that is a bit clearer:

A man walks into the doctor with a cough. The doctor listens to the cough and says "ahhhh you have a cold". After listening to the cough a bit more...he then clasifies the cold as a type A cold. The man has a no fever...so the doctor classifies the cold as a "type A-NF" cold... On and on.

The doctor does not ask where he works. If he has been around other people with colds, if he smokes...

If the man worked in an asbestos factory and smoked 6 packs of cigarettes a day...he might not have a cold.

Functional analysis involves asking the question :"why is the man coughing?"

Considering that they are most likely giving a large number of children with genetic narcissism meds for ADD...Possibly causing lifetime issues...I think that a functional analysis is called for. Why is there ADD...why is it problematic? Why is it problematic for this person.

They are running at it in the wrong direction...in every cough they will find five more subtypes.

They are not gods that can figure what is "wrong" (or even if there is something wrong) by not lifting the patient's shirt and asking "why/" instead of "what?"

"Why?" exposes the answer to thousands of "whats?"

Is it a pepper? or a tomato? if it looks about the same...we can only tell by tasting it.

In the end...whether it is a pepper or a tomato...how can we grow it better?

One possible hypothesis, if primarily inattentive patients do not experience the same effects from stimulants, is that the disorder could still be related, but that unlike combined or hyperactive types, the exact cause of a lack of prefrontal catecholamines could be different.
.There are many roads to Rome. Functionally ADD has a purpose and mother nature, bless her heart, has different ways to make that functionality happen...hence subtypes

There is no "damage"...there is however, a difference.

Let me count the ways a neurotransmitter "pathway" could be affected.
Just take a look at Antidepressents and how they act to get a basic idea...then throw in all of the stuff we don't know.

Some of the subtypes are probably not even in the "ADD Basket".


Of course you may think I am nuts for saying this since I do not have a PHd in psychology and am not spouting mainstream or even sidestream ideas. I am cool with that ;) Please do your best to prove me wrong. I am hoping for people that can smash these models to pieces. I am doing my darndest and am having trouble.

Is ADD an aberration? A disorder...if it is what is the order?...not in consensus...but in functional terms. Over a hundred years from Darwin and researchers still don't seem to see it....in nature EVERYTHING involves function.

If you feel that man is created in his creator's image and is above nature...then we have nothing to discuss but mutual respect for our different viewpoints.

Is it a pepper? or a tomato? if it looks about the same...we can only tell by tasting it.
If it's a pepper, but they tell me that the latest research says that it's a tomato, and I try to make sauce out of it, it won't come out too well. Especially if they neglect to tell me that the reclassification only applies to certain types of peppers.

In the end...whether it is a pepper or a tomato...how can we grow it better?
I'm not knocking advanced research, I wouldn't be the least bit surprised if they found more than 3 subtypes of ADHD.

I'm only asking that this research be presented on the forums responsibly. Don't assume that everyone here is familiar with the advanced works of a researcher, and follow his naming constructs when they conflict with the DSM standard.

Yes, let's grow better tomatoes and peppers, but don't go around telling us that research says we should be spraying them with Round-Up, and then later mention, "Oh "Round-up" is the name of a new fertilizer blend, not that stuff you buy in the store, nobody should use that old terminology anymore!" You'd be quite angry! :D

If it's a pepper, but they tell me that the latest research says that it's a tomato, and I try to make sauce out of it, it won't come out too well. Especially if they neglect to tell me that the reclassification only applies to certain types of peppers.


I'm not knocking advanced research, I wouldn't be the least bit surprised if they found more than 3 subtypes of ADHD.

I'm only asking that this research be presented on the forums responsibly. Don't assume that everyone here is familiar with the advanced works of a researcher, and follow his naming constructs when they conflict with the DSM standard.

Yes, let's grow better tomatoes and peppers, but don't go around telling us that research says we should be spraying them with Round-Up, and then later mention, "Oh "Round-up" is the name of a new fertilizer blend, not that stuff you buy in the store, nobody should use that old terminology anymore!" You'd be quite angry! :D

LOL... Adderall brand rat poison...oh noooo!

LOL... Adderall brand rat poison...oh noooo!
:D Hate when that happens!

Yeah these are extreme examples, but I just wanted to emphasize the importance of not using unnecessarily clouded language. Either use the terminology most people are familiar with, or preface the terminology to make it clear that you are talking about a slightly different concept. IE, maybe use "Barkley Inattentive" (vs DSM-Inattentive) instead of just using "Inattentive" and assuming that everyone else is on the same page.

That's all I'm after :)

Do you really think that every mental health professional is attending Barkley's lectures and is agreeing to scrap the DSM guidelines in favor of Barkley's ideas?

It is not just Barkley. He is not some renegade Scientist. He is about as mainstream as they come. There are many in the field who are researching this subtype. Barkley is one of the few who does the public service of conveying information to the public.

Not everyone agrees "to scrap guidelines", remember some have OCD. :)

Scrapping the subgroups used in widely-used, widely published diagnostic criteria and relying on notes taken at a lecture that redefines those subgroups (same name, new meaning) is hardly "best practice".

You make it sound like they have thrown the whole DSM out the window. They have simply tweaked the inattentive subgroup and for good reason. This may not be as clean cut and tidy as you like it but change is needed.

After all these labels are fairly arbitrary, not dictated by science. Barkley could easily leave the three groups intact and create a fourth group exclusively for his SCT people. It would be less prone to confusion.

Here, you are very wrong. If Barkley is asking that the criteria for inattentive subtype be modified, you can bet you're booties that it is based on Science. We are going around in circles here. You can be unhappy with what I am telling you but hey, don't shoot the messenger. Instead, do some research and prove me wrong and then we both learn something.

...But why spend all of this time "classifying"? Does it lead to "new therapies" or is it just a way to find new meds so we can all be the same?..."

Before you can do a new therapy first you need a clean sample group. You can't have a clean sample group if the people in the group have very different symptoms.

Funny you should mention meds. The inattentive subgroup does not respond as well to meds. The information learned through Science may lead practitioners to try other therapies. Not all disorders respond best to meds. People with anxiety actually do better with cognitive behaviour therapy( I think that is the name) over time. Perhaps it will be like that with this new subgroup.

It is not just Barkley. He is not some renegade Scientist. He is about as mainstream as they come. There are many in the field who are researching this subtype. Barkley is one of the few who does the public service of conveying information to the public.

Not everyone agrees "to scrap guidelines", remember some have OCD. :)
It sounds like very few people are willing to make this change apart from you. See Mctavish's comments on the DSM above.

It doesn't matter how mainstream Barkley is. It doesn't matter that he sits on the DSM committee. Your congresspersion can't make laws by himself/herself. For similar reasons Barkley can't unilaterally change the diagnostic criteria. He can advocate it, and that sounds like what he is doing, but he can't change it without the rest of the committee.

And the committee cannot change it without publishing the new guidelines, or it means nothing. Not everyone in the field has access to Barkley's slides.

Here, you are very wrong. If Barkley is asking that the criteria for inattentive subtype be modified, you can bet you're booties that it is based on Science. We are going around in circles here. You can be unhappy with what I am telling you but hey, don't shoot the messenger. Instead, do some research and prove me wrong and then we both learn something.
Science determined that the subtype for SCT must be the existing 'inattentive' subtype, and non-SCTer's must be kicked out of it? It couldn't be named ADHD-SCT or anything like that? Or why not just plain SCT, since it's apparently a separate condition? Why not keep ADHD pure for ADHDers? It must be and can only be called 'Inattentive'?

Wow science is more precise than I thought! :D It's amazing how it can never seem to get the ADHD name itself so precise (Minimal Brain Damage/ADD/etc)

Funny you should mention meds. The inattentive subgroup does not respond as well to meds.
That is Barkley's Inattentive subgroup as opposed to the DSM one, right?

You're spinning this...and that doesn't clarify anything....pointless to go on.

Before you can do a new therapy first you need a clean sample group. You can't have a clean sample group if the people in the group have very different symptoms.

Funny you should mention meds. The inattentive subgroup does not respond as well to meds. The information learned through Science may lead practitioners to try other therapies. Not all disorders respond best to meds. People with anxiety actually do better with cognitive behaviour therapy( I think that is the name) over time. Perhaps it will be like that with this new subgroup.Yes, the new subgroup is ERCM in my models. Heck they are all over the place.
All of the "subtypes" need therapy that is guided by their unique experience in their lives.

I have probably been at least 3 of the 6 subtypes at different points in my life. Sometimes in a day :)

People are not so static (especially when they are ADD). We do develop patterns...because people are (as all animals are) pattern buffers hooked up to an impulse engine. Our patterns are more complex than most animals but our impulses work the same.

So... if the 6 subtypes have the same impulses that drive them...then the patterns that they choose based on their life experience could be different but driven by the same thing...I personally feel that most inattentives have had some degree of abuse in their lives. That is not an absolute...but I was a major innattentive when I came out of an abusive situation as a child.

I am saying that the simplicity that the researchers seek is not in the "patterns" or "catagories" but in the primary impulses that drive people.
Then we can look at the patterns and see if they are functional or not.

ERCM is primarily driven by joining groups with a secondary impulse of "self based" reality building. CM+ (ADD) is primarily driven by self based reality building and joining groups is almost not present or functional (ego-dystonic).

Of course these are my models...they could just be junk...I personally don't care if they are proven to be so. I do care about inserting myself into the discussion and learning what ADD is. My models outstrip every thing I have seen in that they describe ADD and three other functional cognitive types in a simple predictive way.

Occam's razor...I see no evidence of functional models in the current work done by Barkley...although it does support my models :)

The odd thing is that my models only bring one new prediction to the table that I have not seen validated by research...that abstraction is stored in white matter...everything points to this...so I am pretty sure it is dead on.

I will post the ADD neuro model and you can have a looksee.

Originaly post by Chain:
We can argue over whether a tomato is a vegetable or a fruit until the cows come home...the question should be "how do we grow the best tomatoes?"



Let me see...yep brought in the monkey wrench... :D

This tomato friut or vegatable agruement can be simply resolved by one who has an allergy.....a tomato is a citrus fruit..I know I am allergic to all cirtus fruits and toamtoes happen to be one of them. The citric acid is less potient when cooked but if I eat a freshly picked toamto I have the same whelps as I do when I eat a pineapple, orange, lemon, lime, or grapefruit. So tomato is a citrus fruit, according to my body!!!

How do we grow the best tomatoes isn't even a blip on my screen....see the difference isn't in the fruit but how it is percieved......if it doesn't cause whelps then you would view it much differently than one who breaks out every time this fruit is eaten....allergies also allow me to cut to the chase as eating said food no matter which group it is place will still cause whelps.


Inattentive ADD still causes a certain set of difficulties to the one who "suffers" from it. So Chain I agree with you in that functional studies should be of top proirity as it doesn't really matter what sub-type this group fall into they are still in need of assistence.



Original posted by Hyperion:
One possible hypothesis, if primarily inattentive patients do not experience the same effects from stimulants, is that the disorder could still be related, but that unlike combined or hyperactive types, the exact cause of a lack of prefrontal catecholamines could be different.


Like the rest of you I have my thoeries and I too have stated my postion before..no I don't have exact research just observation.....(please note my insanity: I think cancer is caused by virus/particle type exposure in a person with weaken immune to said substance.....medical science is just now beginning to get this)

I believe inattentive ADD is a neuro chemical or maybe even a mechinacal difference in the same brain structures that are effect combined/impulsive ADDers. I believe this effect is the same parts but the exact cause is different. My perspective is simular to Hyperions.....the people in which stimulents are not effective may indeed have a different disorder all thgether or maybe there "defiency" may be more severe....

maybe instead of producing too little dopamine they have a zillion times more dopmine untake sites that the medications do not stop these areas from absorbing too much dopamine...maybe the dopamine they do produce is chemicaly weaker or their bodies don't absorb enough of the nutrients needed for dopamine to be made. So we could stop all the dopamine uptake with chemical but it wouldn't touch the problem because the problem isn't the uptake but the bodies ability to produce the neurotransmitter in signficiant or potient amounts!!!!!!

I observed a loved one dieing of cancer..he had to take tons of pain medications..he took a medication that kept his pioric spicture (stretchy area at end of stomach that open and closes to allow food to enter to intestine and prevent it from being sloshed back into to the stomach during digestion) open ...his cardic spincture had been removed due to a tumor (same thing except before stomach that keeps stomach contense from coming back up and into lungs without cardia spincture one can not lay down flat) He needed to take four time the maximum dose of this poaoric spincture medication for it to work.

The cancer in his intestinal tract prevented him from absorbing the medication...try explaining this to the V.A. :faint: . He also took ritalin for increased energy per doctors order......a week before he died he took ten time the ritalin does he was suppose ( :eek: I almost flipped) to with no effect...why because his body could no longer make the neurotransmitter dopamine no matter how much stimulent medication he took. When he could no longer swallow we had to give the pain medication via patch....the hopsice nurse and I used the four time the spincture medication to configure the pain medication because it was an indicator of how decreased his intestional absorbation was....luckily hospice nurses listen better than the V.A.

Personal note keep medications locked and don't leave key where onery cancer patients can get it even if it is his medications!!! :soapbox:

1) Nutritional absorbation or lack thereof can effect the bodies ability to make the correct amount of certain neurotransmitters....if your body doesn't have what it needs to make these transmitters we can take stimulents till the cows come home but it won't stimulent a thing.....


2) this is my personal theory and has no scienctific backing or basis only personal observation.

3) Citric acid can decrease the effects of stimulent medications because it block the absorbation thereof..isn't it strange that I am allergic to it...


4)presenting inforamtion in area that may be read by new and not yet educated people(general ADD would be one such place) should be done in an accurate and consciece manner....if it is only a theory it should be presented as such...not presented as known fact..it doesn't confuse me but I can see where it may create un-necessary confusion in those not familur with ADD research....

5) Don't take every thing read on the internet as fact do your own checking with medical professional before stopping medications or trying new therphys...this would include but not be limited to herbal supplements!!!!!!

Ya'll are too much.:)

McT was referred to.

Here is on the same topic on a different thread.
http://www.addforums.com/forums/showpost.php?p=222514&postcount=43

Ya'll lost me in the fruit and vegetable isle.:)

Right now, I'm not sure if there will be changes in the nomenclature or not.

My guess is that would take time.

Once again tho, I 'm not sure if SCT has been substanitated or not.

I'm still trying to get my colleagues to follow the guidelines Ive posted before.

I see what everyone is saying and they're degrees of truth on both points.

Personally & professionally, I'm going to sit tight and see what happens.

I think the stumbling block is how an inattentive diagnosis should be done currently for all who come and see you for their initial diagnosis. If they were ADHD and were hyperactive as a child but now as a teenager show no hyperactive symptoms, what diagnosis would you give them?

I have no problem accepting the possibility that SCT may not be a unique disorder.

whetherthe name changes or a new classifcation or what doesn't matter. either way everything Barkley says fits me to a tee. Especially the follwing paragraphs.


"But we will not know any more about treatment if we don’t view them differently, because everyone will assume as you may do, quite naively, that the treatments for one apply to all the subtypes, and they don’t. We have discovered a new disorder and it does not belong here. It needs its own name and its own criteria and it needs to get out of this category known as the disruptive behavior disorders, because it has no affinity for them. So let me show you why many of my colleagues are now slowly coming around to an idea that 10 years ago I argued for. This is a different disorder. Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractable, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention.

"Other things we see in these children: when we bring them into the clinic, and we run them through a battery of neuropsychological tests, they have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. AD/HD children have no trouble with selective attention. And by the way, let’s put an end then, to this metaphor for AD/HD that it’s a filtering problem. Because it isn’t. Real AD/HD has no trouble with filtering, selecting information. AD/HD children perceive the world exactly as everybody else does. These children don’t. These kids have a selective attention problem, which by the way explains something that we have found in about six different studies. These kids make more mistakes in academic work than AD/HD children do, many more mistakes. The problem that AD/HD children have is with productivity; number of problems attempted. The problem with these kids is accuracy: the number of errors made. These kids have a real problem with input coming into the brain, how quickly they can handle it, how accurately they can select it out, and deal with it. These children have memory problems. AD/HD children do not. These children have trouble with getting information out of short-term and longterm memory and doing it correctly. It’s especially so for long-term memory, so that they show a very erratic recall of information. AD/HD children, if they have a memory problem, it’s going to be in a very unusual form of memory we’re going to talk about later today. But this is traditional long-term storage, and these children have some trouble with that, probably for the same reason. They’re not getting information out of memory any more accurately than they’re processing information coming into the brain.

"There are problems with selection, with filtering, with focusing their attention. These children have a very different social profile. The traditional AD/HD child is often a rejected child, because they’re immature and emotional and hotheaded and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the AD/HD children they often wind up as being the least liked, the least popular and most likely to fight. That is their peer group profile. That is what Ken Dodge and his profile of peer acceptance views as the rejected child. And 50 percent or more of AD/HD children are utterly rejected by their peer group; these [inattentive] children, very different picture. These children are overlooked. In Ken Dodge’s taxonomy of social problems, they’re neglected. Why? Because they’re passive, uninvolved. They’re staring, daydreaming, hypoactive, absent-minded, passive. Unengaged is a better term for them. They’re not disliked by the other kids. They’re not rejected by them. The other kids just don’t know them. They’re not engaging. They’re not out there participating. They’re just kind of passive kids. They have more friends than AD/HD children have, actually. These kids tend to be neglected, not rejected. It’s a very different social profile.

"Other differences: there is no affinity of this disorder for Oppositional (Defiant) or Conduct Disorder that we can tell. They basically have the same base rates as the normal population. But many AD/HD children are likely to go on to develop Oppositional Disorder and Conduct Disorder. Forty-five to 55 percent of AD/HD children develop Oppositional Disorder by age 7, and another 25-45 percent move up to Conduct Disorder by ages 8 to 12. AD/HD goes with Oppositional and Conduct Disorder. The inattentive group does not.

"You see another reason why they don’t belong in this group? Those three disorders-AD/HD, ODD, and CD-are all part of a larger category we call the disruptive disorders. The inattentive group isn’t and it shouldn’t be there. Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know.

Yeah, I don't think the name change matters either. What matters to Barkley is that this group be kept pure so that best practices can be developed and that we learn more about this subgroup. Can't do that if combos get mixed into every sample. I'm wagering that's why the word is being spread to use different criteria before 2015 and the DSM5, unorthodox, but ultimately in the best interest of Science and the millions of folks who are "SCT".

"The inattentive group isn’t and it shouldn’t be there. Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know. "

Are the categories mutually exclusive and jointly exhaustive? Specifically, what about someone who appears SCT but responds well to stimulants?

And what about those who appear to straddle categories? Would a person who, say, did some shoplifting in adolescence be thereby exhibitng a "whiff' of impulsiveness?

How does one take the SCT construct and retrodict the behavior of someone diagnosed in adulthood?

And using the shoplifting example again, how long a period of time did the person have to have manifested this behavior?

How much is needed to classify him as ADHD-C?

Are the answers to these questions clear?

DBR

And what about those who appear to straddle categories? Would a person who, say, did some shoplifting in adolescence be thereby exhibitng a "whiff' of impulsiveness?

How does one take the SCT construct and retrodict the behavior of someone diagnosed in adulthood?

And using the shoplifting example again, how long a period of time did the person have to have manifested this behavior?

How much is needed to classify him as ADHD-C?

Are the answers to these questions clear?
As far as I can see the answers are not clear at all, and that's part of the issue I raise.

"Whiff" is not a very scientific, objective term. The DSM is very clear on how the groups are to be divided. Barkley wants a pure group for his SCT type. Fine, but I have yet to see a clear standard or test for separating SCT from the non-SCT predominantly Inattentive ADHDers.

A few people here have adopted Barkley's ideas as the new norm, and they define it according to Barkley's language. That is a problem for people like me, who fall into the inattentive category according to the DSM, but in Barkley's model, I would perhaps be ADHD-C. I say perhaps, because I can't tell for sure, since there's no clear test.

I know some people ask why it matters, "it's just a label". It matters because Barkley is saying that this SCT is very different from ADHD and treatments are different. So if you lead us to think we might be SCT, that's going to make us more pessimistic about treatment potential, and the treatment could fail us precisely because we are pessimistic about it.

I can use myself as an example. Shortly after being diagnosed and starting medication I came here and read infomation that said that ADHD-I was this other disorder. That kind of depressed me, because here I was thinking I was about to be able to turn my life around, and I find that. So even though I was taking the medication, I wasn't seeing much improvement.

When I learned a larger extent of what Barkley actually says, I realized that I would probably be ADHD-C in Barkley's world, it was a relief and it gave me new optimism, and I can see an improvement in me from then on.

I don't want anyone else to fall into this trap, so that's why I keep insisting on more care and clarity when this topic is discussed. Specifically, don't make a blanket statement like "ADHD-Inattentive is a separate disorder", it's irresponsible. The statement is only true if you've accepted Barkley's new subtype definitions as the norm. Most people have been diagnosed according to the DSM-IV. The statement needs to be clarified that it's using a new definition of inattentive, or "some inattentive are" or something.

I agree. And i accept McTavish's statement that Barkley does not want people to be confused about his research as confirmation of what you just wrote.

Of course' "whiff" is Barkley's term, and again, the fact that he used such a vague term demonstrates all the more strongly that he is not trying to dictate new DSM standards by himself.

So clearly the context shows that Barkley is not saying that a doc is a quack for diagnosing someone Inattentive.

What concerns me--as it does you-- are the newbies coming on board who might have the experience you had and I had. This is especially true given the books reviewed and authorites cited. For example, before I joined the Forums, I thought Daniel Amen to be the leader in the field. But I have seen some concerns raised re Amen that at least merit my consideration.

That said, I believe it's best to debate this in the open.

And I agree, clarity in the use of terms is the best way to further the discussion and minimize confusion.

Best Regards,
DBR

I agree with both of you as well. I don't mean to slam Barkley, but "whiff" is frankly ridiculous. He may have a strong opinion on the matter, but that's all it is right now - opinion. Just because he can back it up with some preliminary research doesn't mean that it's going to pan out. A lot of theories about ADHD that had good preliminary research behind them didn't pan out.

I'm seriously annoyed by the Barkley SCT idea, because I'm neither impulsive nor hyperactive, but his description of the SCT type doesn't fit me in the LEAST. I don't think slowly and I don't make a lot of mistakes. (I've wondered if I really fit the inattentive type simply because I'm not sure I make enough errors in my work. I finally decided that I make more than most people, but this is generally because I get distracted while working, and my "mistakes" are the result of not following something through. I'm not sure if that's the sort of mistake Barkley's SCTs make or not.) I was rejected as a child, not overlooked. I've never been mistaken for "slow," and I'm more distractable most of the time than I am spacey. (Although I have my spacey moments.) I have temper and productivity issues. I'm not confused, I'm not passive and I'm not shy.

I'm also WTFing over Barkley's statements that ADHD combos DON'T have filtering and memory problems. That contradicts every damn book I've read on the subject so far, so I'd sure as heck like to know where he gets that from.

Please keep this in perspective. To the best of my knowledge it hasn't been substantiated, or at least I haven't heard that.

Russ is one of the most serious scientist's you'll ever meet in your life.

There is no way he'd jump the gun on something like that.

The way I read it, he is describing what he thinks might be happening BASED ON THE DATA.

If it were to change tomorrow, he'd change with it.

If it truly exists then I believe he'll find it. If not, he'll do a good job of searching.

I went back and researched a bit a about what Barkley actually says about Inattentive and SCT.

http://www.addconsults.com/articles/full.php3?id=1389
Dear Dr. Barkley,

I am interested in hearing more about the inattentive subtype of AD/HD. From reading your work on this, it seems that your take is different from others in that you believe it is a distinct and separate disorder.
Could you elaborate a bit more? If this is a separate disorder, then how would you classify it?

Do you see treatment as being different than for the hyperactive type of AD/HD?

Thank you for your time.

Suzanne D'Loren, MSW
Salem, MA

· Dr. Barkley responds:

Accumulating research is suggesting that a subset of ADHD children qualifying for the Inattentive Type may have qualitatively distinct symptoms, comorbid disorders, and impairments than do Combined Type children.

Evidence suggests that this subgroup may comprise 30 percent or more of children now placed in the Inattentive Type. This subset of children appears to manifest deficits in information processing in which they are sluggish, error prone, and poor at selective attention tasks.

Clinically, they are described as having an increased level of lethargy, hypo-activity, daydreaming, spaciness, mental confusion or fogginess, and forgetfulness.

As a result, they have been dubbed by some researchers as Sluggish Cognitive Tempo, or SCT.
I've highlighted and emphasized a key portion. Barkley is not even claiming that ADHD-I equals SCT. He says that SCT is a subset (and a minority one at that) of ADHD-I diagnosises.

http://www.continuingedcourses.net/active/courses/course003.php
A recent study by Carlson and Mann (in press) indicates that if the subset of I-type children characterized by these SCT are separated from other I-type children not so characterized, then greater problems with anxiety/depression, social withdrawal, and general unhappiness and fewer problems with externalizing symptoms may be more evident in this SCT subset.
Again, SCT is referred to as a subset of ADHD-I by Barkley

What about the comments that anyone with a 'whiff' of hyperactivity/impulsivity should be diagnosed as 'combined'? Well, those came from these slides, and they are over five years old:
http://www.schwablearning.org/pdfs/2200_7-barktran.pdf?date=4-12-05

More recently, Barkley seems to have been supporting a classification scheme that divides ADHD-I into four subtypes. (sub-subtypes?) These are labeled subtypes A-D. SCT is inattentive subtype C. I would probably be inattentive subtype A under this system.
Details here: http://www.m-net.co.il/english/lifestyle/health/adhd.html

So, can we please, please stop posting information that says that either ADHD-inattentive is a separate disorder or ADHD-inattentive is the same thing as SCT? It's inaccurate and irresponsible. Barkley, the person cited for this information isn't even making that claim. :soapbox:

I appreciate the passion and the different points of view that have been shared. Thank you all! :)

It seems that everyone has had an opportunity to voice their feelings on this matter. If you haven't and have something new to add, please pm me.

This thread has been temporarily closed, to give everyone time for reflection. We've also drifted badly off-topic. :eek:

Thanks for your participation.

Wheezie