"No scientific basis" - Here's the Proof

[mctavish23]

The exact etiology of ADHD is unknown. No one is claiming to know that, at least not right now. However, in regards to statements about there being "no scientific basis"(/B) for these disorders,

Here's the "proof" : These are ALL from unrestricted research grants published in (the cream of the crop) peer reviewed journals.

1) The neurobiological nature of ADHD.....THE PROOF YOU SAY DOESNT EXIST: was conclusively proven in the 1990 landmark glucose brainscan research study published in the New England Journal of Medicine....


Zametkin,A.J.,Nordahl,T.E.,Gross,M.,King,A.K.,Semp le,W.E.,Rumsey,J.,Hamburger,S.,& Cohen,R.M.(1990) Cerebral glucose metabolism in adults with hyperactivity of childhood onset. The New England Journal of Medicine,323,(30).1361-1366.

The "proof" is in the PET scans that showed that the harder a person with ADHD concentrated the "slower" their brain went vs the exact opposite for the non ADHD group. However, that was remedied when the ADHD subjects took stimulant medication.

THE definitive study proving the existence of ADHD as a "real" disorder;signed off on by over 80 of the world's leading scientists (with over 19 pages of references) is :

Consortium of international scientists:International Consensus Statement on ADHD, January 2002. (http://www.chadd.org). It can also be viewed at Russell Barkley's website.


You can turn to pages 22-24 of Sandra Rief's 2003 book.............The ADHD Book of Lists ....................to find the section (1-7) WHAT THE RESEARCH IS REVEALING ABOUT ADHD

Within that section is the reference for the Landmark MTA Study:

"There has been significant research with regards to treatments for ADHD and their relative effectiveness. The longest and most thorough study of the effects of ADHD interventions was the 1999 Multimodal Treatment Study of Children with ADHD (MTA) by the National Institute of Mental Health (NIMH).

MTA Cooperative Group" A 14-month Randomized Clinincal Trial of Treatment Strategies for AD/HD,"[i]Archives of General Psychiatry, 56:1073-1086;1999.

ADHD is primarily thought to be largely (80%) genetic/inherited.THE GENETIC LANDMARK FOR ADHD WAS FOUND IN 995. That study is as follows:


Cook,et.al.,(1995) Association of attention-deficit disorder and the dopamine transporter gene.American Journal of Human Genetics,56.993-998.

The US Surgeon General's Report on Mental Health: Chapter 3: Disorders of Infancy, Childhood & Adolescence has excellent background info supporting in great detail (with another 19 pages of scientific references).Here's a small segment on what I'm talking about:
" The exact etiology of ADHD is unknown,although neurotransmitter deficits,genetics and perinatal complications have been implicated." It goes on to say:

"Research to pinpoint abnormal genes is honing in on 2 genes;a dopamine receptor gene (DRD) gene on chromosome 11 and the dopamine -transporter gene (DAT1) on chromosome 5 (Cook,et.al.,1995:Smalley,et.al.;1998).

The latter reference is : Smalley,et.at.(1998) Evidence that the dopamine D4 receptor is a succeptibility gene in attention-deficit hyperactivity disorder,Molecular Psychiatry,3,427-430.

Recently (3/25/05), I participated in a teleconference on ADHD in children put on by United Behavioral Health (UBH: a managed care company). The presenter was Russell Barkley, PhD. He is largely viewed as the world's leading researcher on ADHD. During that presentation, he listed the following (evidenced based/research derived) data regarding the neurology of ADHD.

Decreased Cerebral Metabolism
(from Thomas Spencer, M.D.)

global and regional glucose metabolism by PET scan reduced in adults who have been hyper since childhood (thats Zametkin's research again).
Largest reductions in:
1) pre motor cortex
2) superior prefrontal cortex

Anterior Cingulate Dysfunction in ADHD, fMRI and the Counting Stroop.
Bush,et.al.,(1998).


Etiologies-Neurological

Smaller, less active,less developed brain
Regions found on MRI,fMRI and PET scans incluse the following areas of the brain:
1) Orbital-Prefrontal Cortex( primarily on the right side)

2) Basal Ganglia (mainly striatum and globus pallidus)

3) Cerebellum (central vermis area, right side) - there were some other posts about this particualr area of the brain being a key component of ADHD in a different thread I believe

Suspected Neurochemical Deficiency:

1) Dopamine dysregulation likely but not definitive....... the mere fact that stimulant
medication works at all to relieve symptoms of ADHD forms a solid basis
for helping to substantiate this (and the first medication study was done in 1937 in
Rhode Island)

2) Norepinephrine dysregulation probable

Etiologies- Genetic ( these data were all derived from research studies) The usual maker for statistical significance is 1.5 SD (standard deviation) 's from the mean, which equates to a %tile ranking of 93. In other words, the absolute lowest chance of these data being accurate is 93%.

1) Family aggregation of the disorder: 25-35% of siblings; 78-92% of idnetical twins;15-20% of mothers, and 25-30% of fathers; If the parent is ADHD, then theres a 20-54% chance of the offspring being ADHD (increases the odds 8fold)

2) Twin studies of Heritability 57-97%)

3) Shared environment 0-6% (not significant)

4) Unique environment (15-20% )


Molecular Genetics : Candidate genes on DRD4,DAT1,DBH-Taq1 (on chromosomes 3,5,and 11)

Candidate region: chromosome 26p13 region


Lastly, the answer to your questions about the difference between ADHD and ADD can be found in Barkley's ADHD and the Nature of Self-Control (1997).
It's also addressed in his 2002 book Taking Charge of ADHD (pages 137-138) and in You Mean Im Not Lazy,Stupid Or Crazy? by Kate Kelly & Peg Ramundo (Chapter 2).

As for depression, it is considered to be a Medical disorder on the basis of the chemical imbalance of the neurotransmitter serotonin. I don't know anyone who considers it to be a "disease".

There's no cure for the common cold but people know it exists. The Biogenic Amine Hypothesis was derived (via research) over 20 years ago. Here's what that says: "The concept that abnormalities in the physiology and metabolism of certain biogenic amines, particularly catecholamines[i](norepinephrine and dopamine ) and an indoleamine(serotonin) , are involved in the causes and courses of certain psychiatric illnesses."
That qoute was from an older issue of A Psychiatric Glossary of the AMerican Psychiatric Association, page 28. The new one is at the office.

The Biogenic Amine Hypothesis is what eventually led to the development of the class of antidepressants we now know as SSRI's (Select Serotonin Reuptake Inhibitor's:Zoloft, Prozaz,etc.).


This MORE than refutes your remarks. As of the summer of 2003 there were over 6k research articles,professional papers, chapters in book and books on ADHD.

If you go to the International Consensus 2002 journal article, you will also find on page 89:

"ADHD is recognized as a disorder/medical condition by the American Medical Association, the American Psychiatric Association, the American Psychological Association and the American Academy of Pediatrics."


THIS ISN'T AN EXACT SCIENCE .NO ONE EVER SAID IT WAS. But I can tell you that a T score of 70+% on the Conners Parent Rating Scale is one of the most accurate predictors of ADHD currently available (when used in concert with a thorough developemental and medical screening, behavioral observations and other screenings for executive functions; to name a few).


I could go on but I've made my point. I spent hours on this post and still had to cut it short. There's your scientific basis.

[Fly Away]

Thank you!

[clawless]

Great Post

[Andrew]

where's the reputation system when you need it? Great post!!!

[ADDitives]

i always think its funny when people try to give you the argument of "well ADD isnt real, there are no real medical tests. you dont have a blood test for ADD so how can you prove"

let me go through all the things wrong in that argument...

* since when was a blood test the only 'real' or 'valid' way of determining something?
* i didnt know my ADHD was flowing around in my veins!
* AD(H)D doesnt have a blood test because its in your BRAIN! do they take a blood test to determine whether your depressed? is schozophrenia not real because it cant be determined with a blood test? anxiety? hmm....


and i hate it when people say "i dont believe in add, i think its just bad parenting"

they obviously dont know the first thing about add, and they just think its the childhood classroom disruption syndrome.

how wrong they are...

just a few thoughts!

[crazymama05]

Thank you mctavish23.....awesome post!!! I am printing that out and carrying it with me forever. Then I wont need to try to quote it verbatim!!!

[KnittingJunkie]

Rock on! Thanks, man. ~Chrys

[Imnapl]

Thanks.

[alex111]

Very important post. We need to ounce and for all put an end to the myth of ADHD being some kind of "imaginary" disorder. We need to make the general public aware of the scientific evidence behind all this. The post was a step in the right direction...

[Albino Fox]

Great collection of info there...

Only problem is the countless formatting errors to be fixed up to make it more readable. As I'm an OCD ADDer, it all kinda bugs me and makes me want to spend countless hours neatening it up from its disorderly state. (As a matter of fact, I've failed to resist, and there's a mostly fixed-up copy of it I have saved somewhere now.)

I even get the feeling that... what we need is an ADHD wiki. Y'know, a Wikicity. That would keep things like these all in orderly documents, where all the OCD ADDers are free to edit away at the others' articles.

[Ian]

Albino Fox I've added a couple of references to the wikipedia site. Maybe you could work some magic there too.

[BlessedLady]

Great Post ! Thank you so much for the time & work you put into it.
BlessedLady

[CynicallyNaive]

Good post/thread. I do want to draw an important distinction, though:

Some, like Lynn Weiss, would argue vehemently that ADD exists as a particular brain structure but not as a disorder. (Although she objects to the term ADD, she uses it for clarity of language.) I think this is entirely plausible, as the psychological establishment is constantly evolving in its views of what is and isn't a pathology. For example, homosexuality was once considered a disorder but now (AFAICT) is not by most psychologists. Yet that doesn't preclude a genetic or physiological disposition toward homosexuality -- just that it's no longer seen as a sickness in need of a cure.

I'm certainly no psychologist, but from my perspective as an ADD person I see no reason why today's "disorder" shouldn't be tomorrow's... err, "mere difference".

[Ian]

If it weren't for the many myths and divergent views, my personal situation could be a lot less confused by misinformation. What I like about this post is that the information has held up to the scientific method. That's a rare and wonderful thing on a message board.

I went to watch a friend defend his Masters thesis last month and it almost made me want to go back to school!

We battle here here on the forums constantly to uphold what is proved and submitted to substantial peer review. The web is full of people able to say anything they like, but here in this thread, we could use your support in bringing to light information of substance. Not because it "feels right" or that one can find others that believe it to be true also, but because it meets the rigors of science and rational investigation.

If the information you provided regarding Lynn Weiss's position has been subjected to the standards that this thread is based on, I'm all ears, but I've heard enough conflicting commentary on ADHD to be sick to death of the signal to noise ratio.

With that said, it would help to make your case it you quoted details like have been provided for you and all of us in this thread about sources and support for the position. I'm sorry if this comes off like I'm hot, but I am.

Too often the degree of care and attention to verify sources and qualify information is not appreciated, but that's not been the case with this initial post. I'm here to defend the integrity of such strongly documented and verified statements as was posted first. There are others not in positions of authority here that do the same. I'm not alone. We have thinkers among us. Speculation is another matter entirely and we have room for that here too and embrace it fully. See almost anything by some fine members like chain, SB_UK and stabile. It doesn't get much more bleeding edge than some of the corners those guys are trying to shed light on.

Welcome to the fish bowl.
Cheers! Ian.

[CynicallyNaive]

Ian,

Thanks for the reply. I'm also a believer in peer review (as evidenced most recently by my fascination with wikis!) so I have no problem with you asking me to defend my position.

I'm a little confused, though -- are you objecting to Weiss's position that ADHD is a different brain structure but not a disorder? (The book I'm referring to here, ADD on the Job, is one of three cited by Kimalimah on the Careers/Job Impact forum. While that's not exactly the level of authority conferred by a peer-reviewed journal, it certainly implies that someone on this site takes Dr. Weiss's views seriously.) Or are you objecting to my own assertions -- admittedly unsubstantiated -- about the psychology establishment evolving in its view of pathologies?

Also, it seems you think I'm trying to refute the OP, which wasn't my intent at all. To the contrary, the OP makes a very convincing case about ADD as a very real physiological phenomenon. I'm just raising questions about its nature as a disorder because frankly, I don't think this part of my personality is pathological! I don't see that this puts me in opposition with the point of this thread, but maybe I'm not fully grasping some aspect of it.

I don't mind seeking more substantiation, but I'd like to know whether you're finding fault with my idle speculation or with Weiss's published opinion.