No, I'm not talking about those who are nervous about the side-effects and longer-term effects of the potent stimulants like those used for AD/HD. And I'm not even talking about those who would prefer to find a "natural" solution to AD/HD (although personally I believe that all the natural solutions other than good old fashioned diet and exercise -- which, let's face it, is good for EVERYTHING -- are probably due more to a placebo effect than anything else).

No, I'm talking about the whole "AD/HD doesn't exist, and the purpose of the diagnosis is to allow the drug companies to sell more drugs to our children" brigade.

The arguments they make are the same old tired arguments we've all heard (There's no medical test for AD/HD! Ritalin is chemically similar to cocaine! Some kids abuse Adderall! The boogeyman is coming), with a huge amount of alarmism thrown in (think of the CHILDREN!).

Has anyone done a randomized test of Dr. Amen's SPECT images? IE, get a group of N children, where roughly N/2 of them have been diagnosed (using the DSM criteria) with AD/HD. Then scan them ALL with SPECT, and using the SPECT images during concentration trials, determine which have AD/HD. If the DSM diagnosis and the SPECT imaging diagnosis correlate well, I'd say that's pretty darned firm empirical proof that there's SOMETHING there. Something organic.

Also what's this whole thing about "well if it's just due to bad parenting [Tom -- BAH! I hate this line!] then we shouldn't treat it with drugs!"

People wake up -- all of your thinking and emotions is neurochemistry. If you get sad or nostalgic, various neurons have fired, neurotransmitters have changed levels, and electrical currents have flowed. If there's a subjective brain state that's caused 100% by "genetics" and another that's caused 100% by "environment" but both states feel exactly the same and both states produce exactly identical brainwave patterns, and if we have a drug that effectively "treats" the "genetic" version -- why shouldn't we use that same drug to treat the "environmental" version?

I guess what I'm getting at is that in reality, there's no distinction between "nature" and "nurture." "Real world events" cause changes in brain chemistry, which cause more real world events (because the person reacts), and so on and so on. If there's a drug that "cures" the condition -- USE it! Don't spend all your energy debating how many angels can dance on the head of a pin!

Obviously, you want to use meds sparingly. Given that we know so little about the very long-term effects of many meds, it's wise to be sparing. But sparing is not the same as don't use them! Let's face it, we addults have struggled with ADD our whole lives (according to the DSM definition!) We've tried every trick in the book, we've tried "willpower," many of us have used illegal drugs or legal drugs to excessive or abusive amounts. I mean folks, we've tried to solve the problem without meds and nothing worked! So why, when presented with the possibility of a med that DOES work and DOES allow us to FINALLY lead a happy, productive life -- why does this prompt some people to go into hyper-debate mode ("It depends on what the definition of 'is' is...") and argue big philosophical issues about medicine -- rather than just USE the darned drugs.

I know that most of the furor about AD/HD has been over medicating children, but a lot of the vitriol spills over. I've had people tell me (a supposedly fully grown man) that I'm stupid, that I'm duped, that I'm just lazy and don't want to take responsibility for my life -- rather than have people accept that I have a brain disorder. Why???

Ok -- end rant...

-- Tom

Oh by the way -- there's no "medical" test for depression either. Does that mean the depression doesn't exist too?

Grrrrr...

-- Tom

Interesting you should say that...

While this test (and others on the Internet) should not replace an official diagnosis by a doctor, here's an online "depression test"
http://www.mentalhelp.net/poc/view_doc.php?id=973&type=doc&cn=Depression%20%28Unipolar%29

I was at one point anti-meds because of my own experience and witnessing the students I worked with just being thrown on medicatioin that's it. There are so many professionals "treating" AD/HD with out knowing enough about it. Many just prescribe medication that it's it the basicly boot you out the door.

Medication does not cure AD/HD. It many cases it can help people as part of an AD/HD managment plan. Many are given the false sense that medicatioin cures AD/HD and when the newness of the medication wears off people start to think that the medication has stopped working because their lives aren't perfect.

I really think that professionals who treat AD/HD really need to educate themselves more about AD/HD. Also we as ADDers really need to educate ourselves before trying any treatment/management option.

Big -- thanks for that link :) I've taken the Beck depression inventory before too and I think those questionnaires are all good. But I think that the point I was driving at is that there's no biological test for depression as of right now -- I can't go into the doc's office, have him draw blood, get some labwork done, and come back "depression positive." Of course, my argument is this doesn't mean anything -- just because we don't have a lab test yet doesn't mean it doesn't exist. But the "ADD is make-believe" people think that this means it is all made up!

Livingwithadd:

I agree 100% -- meds don't cure ADD any more than antidepressants cure depression. I think I recall something like these figures (vague recollections, so sue me if I'm wrong...): 30% of depression can be 'cured' (go into permanent remission) with meds alone, 30% can be 'cured' with therapy alone, and 60% can be 'cured' with a combination of meds and therapy.

I think that this makes sense. Again -- our brains ARE chemistry. I know that people have different moral and religious reasons for resisting this idea, but I honestly believe they're spitting against the wind. Every bit of evidence that we have, from the results of accidents that damage the brain (think of Phineas Gage), to studies of organic brain defects, to the very efficacy of antidepressants, anticonvulsants, and even hallucinogens (oh my) -- all this evidence points back to one pretty much incontrovertible point: we are our brains. Or more specifically, our subjective perception of reality is completely based in our brains. Whether we have a 'soul' or something more ephemeral is still up for debate, but I think that the verdict is pretty much in that our thinking and emotions and memories are all grounded in our brains.

So this would tend to support the "you can cure it with meds" school of thought, right? Wrong.

Lemme give you an analogy. Let's say I have a car that's malfunctioning. It's a very mild (relatively speaking) malfunction -- once in a while, under acceleration on cold mornings with the blinker on, the car sputters and stalls. So I take it to the mechanic, and he finds the cause -- an interior bearing isn't getting enough oil, and it's seizing up (this is a totally made-up example folks so don't shoot me for stretching the rules of the internal combustion engine a little :)

This is akin to depression, or ADD. It IS a physical problem -- you can point to a specific part of the engine or area of the brain that's malfunctioning. Psych drugs are like dumping 10 quarts of oil into the engine in an attempt to get more oil to the malfunctioning part. This will have the effect of getting more oil to the malfunctioning part, and possibly relieve the initial problem. But this is a systemic solution -- ie this additional oil would affect ALL the parts in the engine, including other parts that were functioning fine. It might well cause other parts to start misbehaving, or just produce bizarre but still tolerable side-effects (black smoke in the exhaust, sluggish acceleration, etc etc -- stuff you can live with, but isn't 'ideal').

That's where we're at today -- brain drugs can and do help. Otherwise Prozac would have never made it out of clinical trials! But these drugs affect the WHOLE brain -- your whole brain uses serotonin, not just the "depressed" parts! That's why a drug can never go in and just "fix" the one "broken" part -- they aren't that specific.

When you add the fact that most mental illnesses are "spectrum" disorders, it gets more complicated. By spectrum, I mean that even in ADD, say, all of the symptoms are just normal symptoms taken to extremes. IE, distractibility, procrastination, forgetfulness -- EVERYONE gets these problems. It's not that we (ADD'ers) are qualitatively different from everyone else (as much as we want to try to convince ourselves that we're different and special :) -- it's just that we do these behaviors to a much greater degree. It's also why the proper diagnosis of a mental illness is so difficult -- the "grey" areas make it more than possible for your single brain deficiency or abnormality to cause more than one mental illness or to seem like two totally distinct illnesses. We need to have an extremely detailed brain map that correlates location to function, and be able to tie various subjective symptoms back to this brain map with great accuracy. Just saying that ADD results in decreased metabolic activity in the prefrontal cortex during concentration is totally insufficient -- do you have any idea how many neurons are in the prefrontal cortex? And I can guarantee you that they don't all function to maintain focus and concentration... That's like saying your engine problem is "somewhere near the front of the engine" -- it helps narrow it down but doesn't do much else... Until we can be so precise with our brain imaging, mental illness diagnosis will be an art rather than a science, and it will be reasonable to say that ADD, for instance, is just normal behaviors (forgetfulness, impulsiveness) carried to extremes and given a "diagnosis." I guess "normal" people don't realize how much these "normal" behaviors can disrupt your life when carried to extremes, so they resist the whole diagnosis -- who knows.

Now -- I think we will eventually be able to treat these problems medically. However, it will be in the format of tiny electrical stimulators implanted in the brain that will trigger individual neuron circuits -- or at most tiny clusters of circuits. This will allow us great specificity. But many people will be frightened of brain surgery, and many more will be frightened of the implications of "mind control" that these devices will carry. Oh well -- too bad for ya. I personally plan to be in line for my implants from the moment they're considered safe and effective.

Ugh, I'm rambling a lot today...

-- Tom

There's no doubt in my mind that AD/HD is related to a chemical difference in the brain. But, medication is not the only things that changes the chemical in our brains. Medication does change the brain chemistry more quickly and more draticly than other things though.

There have been studies done about people with OCD who went through behavioral therapy and were not on medicaton. They did scans of these people's brains before the therapy and after the therapy. After the therapy the brain scan changed and appeared to be more "normal".

I agree the the brain is very complex. I don't think many people realize that everything things that we do and out into our bodies affect our brains.

Getting back to the medication issues. I think if a person has found a managment plan to help with AD/HD that is great whether it invloves medication or not. We are all different.

I agree with several points here. First, I agree that the debate about whether an adult should or should treat with a medication is really a pointless debate. The fact is that a person with ADD suffers so much stress from experiencing the symptomology and not being able to function, that we should be looking more importantly at the side effects of not being medicated...ie; blood pressure, loss of marriages, depression, loniliness. low achievemnet, prison time, etc...these are life shortening experiences if experienced repeatedly on a regular long term basis. The side effects of these drugs are a "maybe" while the side effects of the stress is not a maybe. What if I told you that if you took a particular drug, I could assure you that you would be changing jobs, changing relationships, and forgetting a lot of things all the time, making you relatively incapable of functioning. Would you take the drug? Of course not! What if all these things were happening to you because you did take the drug, and I came to you and said here is another drug, and it will stop some of these bad things from happening, and make it easier for you to control the other things. Would you take the second drug? Hmmmmm...now you have to think about it? I would take the 2nd drug in a heart beat. I'd leave the behavior management stuff to take place after I got some relief and could function well enough to actually follow thorough on a behavior management plan. If you have ADD so bad tht you can't be on tome to your behavior management appt, well, I think you have few choices...take the drug!!!!!

Behavior management can be helpful as well, as so can therapy. I am involved in many aspects of psychology and therapy, but I don't think I would want to tell my brain chemistry that it is on its own from now on.

I also want to say that I don't think ADDers are abnormal. I think we are as normal as anyone else. That doesn't mean we can't use a prescription to help us overcome some difficult things in our lives.

Thats all....

Jon

I didn't see anybody debating whether one should or shouldn't take medication in this thread.

Atomx -

Although it didn't start that way, I read your essay as a statement on whether adults should or should not spend time debating whether to take or not take drugs. In the middle of your essay, you wrote the following which I interpreted to be a statement about taking drugs to treat ADD. Did I get the wrong message atomx or were you making a statement?

" Also what's this whole thing about "well if it's just due to bad parenting [Tom -- BAH! I hate this line!] then we shouldn't treat it with drugs!"

People wake up -- all of your thinking and emotions is neurochemistry. If you get sad or nostalgic, various neurons have fired, neurotransmitters have changed levels, and electrical currents have flowed. If there's a subjective brain state that's caused 100% by "genetics" and another that's caused 100% by "environment" but both states feel exactly the same and both states produce exactly identical brainwave patterns, and if we have a drug that effectively "treats" the "genetic" version -- why shouldn't we use that same drug to treat the "environmental" version?

I guess what I'm getting at is that in reality, there's no distinction between "nature" and "nurture." "Real world events" cause changes in brain chemistry, which cause more real world events (because the person reacts), and so on and so on. If there's a drug that "cures" the condition -- USE it! Don't spend all your energy debating how many angels can dance on the head of a pin!

Obviously, you want to use meds sparingly. Given that we know so little about the very long-term effects of many meds, it's wise to be sparing. But sparing is not the same as don't use them! Let's face it, we addults have struggled with ADD our whole lives (according to the DSM definition!) We've tried every trick in the book, we've tried "willpower," many of us have used illegal drugs or legal drugs to excessive or abusive amounts. I mean folks, we've tried to solve the problem without meds and nothing worked! So why, when presented with the possibility of a med that DOES work and DOES allow us to FINALLY lead a happy, productive life -- why does this prompt some people to go into hyper-debate mode ("It depends on what the definition of 'is' is...") and argue big philosophical issues about medicine -- rather than just USE the darned drugs."

Thanks for clarifying AtomX

Jon

Tara - ...I don't know...maybe I read into his words and saw my own beliefs being reiterated, and saw atomx mirroring what I believe, and I saw in that a debate on drugs? But I didn't think anyone here was saying that people should not take drugs. I did not think you were speaking against drugs. You weren't saying that, were you? I was just voicing my opinion about the topic of taking or not taking drugs for ADD, in general, which I thought Atomx was talking about.

Jon

I wasn't claiming anyone here was saying "don't take drugs for AD/HD." At one point I thought livingwithadd was saying that, but after talking it over, I've come to realize that all she's saying is that she doesn't take them herself.

No, my rant was against people outside of this community; the folks on chat who like to come in and claim that AD/HD isn't real, that it's a fad diagnosis, that we're just drug addicts looking for a fix.

That gets me riled up -- obviously :)