Origin of ADHD has everything to do with proper treatment.

[Peripheral]

The DSM does not address causation, and that's why you're not going to see anything about "emotional pain." Barkley here is addressing a diagnostic issue, and explaining why different outcomes indicate the need for different diagnostic criteria.

Causation is not relative to the discussion. The discussion is about possible changes to diagnostic criteria that would hopefully improve treatment and intervention strategies by more targeted pharmaceutical approaches.

I would suggest that if anyone feels the psychological origin angle needs further discussion, it take place on another thread, as it is off topic on this one.

Cause has everything to do with subtypes.

What kind of doctor is not interested in the origin of the health issue that they are treating?


If a person cuts themselves,

I would hope the doctor would check the type of cut,

and what the person was cut with.

Before the doctors decides the severity of the damage,

for a proper diagnoses.


And then decide what the best treatment is.


The origin of ADHD should be the first question.


.

[Drewbacca]

They put their best guess into the DSM. That's not to say that no one is investigating causation or considering other possible factors. Until there is definitive knowledge regarding causation, it doesn't benefit clinical therapists or psychiatrists to make the DSM three times as thick and filled with ifs, ands, and buts.

You're seeing this in black&white and missing the point. What goes into the DSM is an entirely different set of guidelines than other on-going research regarding causation. Don't look at it as a failed priority; it's a different issue entirely.

[Peripheral]

Originally Posted by Drewbacca

They put their best guess into the DSM. That's not to say that no one is investigating causation or considering other possible factors. Until there is definitive knowledge regarding causation, it doesn't benefit clinical therapists or psychiatrists to make the DSM three times as thick and filled with ifs, ands, and buts.

You're seeing this in black&white and missing the point. What goes into the DSM is an entirely different set of guidelines than other on-going research regarding causation. Don't look at it as a failed priority; it's a different issue entirely.

If that's the case.

I agree with Dr.Barkley,

the DSM's are useless, and abandon the patient.

[Fortune]

The DSM is a diagnostic reference manual. You don't go to it if you want complete information about a particular condition. At this point I've probably read more words about autism than are present in the DSM-IV, and probably a similar number about ADHD. Most of that information is not - and cannot be - in the DSM.

[Peripheral]

Originally Posted by Fortune

The DSM is a diagnostic reference manual. You don't go to it if you want complete information about a particular condition. At this point I've probably read more words about autism than are present in the DSM-IV, and probably a similar number about ADHD. Most of that information is not - and cannot be - in the DSM.

Emotional Pain is a pretty big subject to miss.

For disorder with emotional regulation.

That is my point.

Emotions are not some fantasy,

emotions are physically real.

Anxiety, Depression, Addiction, Conduct Disorder...

[namazu]

Originally Posted by Geronimoo Back-Y-Rita

What kind of doctor is not interested in the origin of the health issue that they are treating?

This is an extremely important question -- for prevention, and often, for treatment. But the answer isn't always knowable.

If a person cuts themselves,
I would hope the doctor would check the type of cut,

This is really all the DSM does -- provide a set of rough guidelines to determine if a person has a cut, and what kind it might be, based on what it looks like from the outside.

and what the person was cut with.
Before the doctors decides the severity of the damage,
for a proper diagnoses.
And then decide what the best treatment is.
The origin of ADHD should be the first question.

This part is much more difficult at this point...

The science just isn't there yet to allow us to pinpoint the exact causes for a lot of "cuts".

Many, many people are working to figure it out,
approaching the question from all different angles.

But meanwhile, there are a lot of people who can't wait for decades for all of the research to shake out, and need treatment based on what we do know at this point.

So good doctors use the DSM,
up-to-date scientific research,
and what they know about each patient's
medical,
social,
family,
educational,
and developmental
history,
to make their best guesses as to what the problem is, what caused it, and how to make it better.

Prevention of impairment/disability is a tremendously important goal, and knowing the true causes of disorders (including contributions from genetics and family environment) is vital for that effort.

But there are also people who need treatment now, and without having all of the answers, we end up making do with rough guidelines and best guesses and clinical experience and population studies and individual responses.


[EDIT: I think there are plenty of clinicians and researchers who would agree with you that emotional dysregulation ought to be mentioned in descriptions of ADHD.]

[Fortune]

Originally Posted by Geronimoo Back-Y-Rita

Emotional Pain is a pretty big subject to miss.

For disorder with emotional regulation.

That is my point.

Emotions are not some fantasy,

emotions are physically real.

Anxiety, Depression, Conduct Disorder...

But diagnosis of ADHD is not based on emotional pain. No one is saying that emotional pain doesn't exist. I do not think ADHD causes greater emotional pain just for being ADHD, but the impairments can and do create emotional distress which is painful. I don't see why you want to center it as the primary thing.

[Drewbacca]

Originally Posted by Geronimoo Back-Y-Rita

That is my point.

But you are assuming that we don't care about causation, a position that no one has taken today.

When you purchase an automobile, it comes with a manual. The manual is sized to fit in the glove box. It tells you how often to change the oil, how to change out a spare tire, how to use the stereo, etc.
However, when it's time to change out the shocks&struts or do brake-work, you pull out the maintenance manual.

Two different books with two different purposes. In this case, the DSM is like the smaller manual while the ongoing research fills the role of a book specifically written for a mechanic.

I really don't understand why you are getting so worked up over this and failing to see that no one is disagreeing with the necessity to consider all causal factors. It's simply a matter of putting the info in the proper place.

[Fortune]

Also, the DSM-IV-TR has 955 pages.

Where would they put the etiology discussion? For each and every condition listed?

[Peripheral]

Originally Posted by namazu

This is an extremely important question -- for prevention, and often, for treatment. But the answer isn't always knowable.


This is really all the DSM does -- provide a set of rough guidelines to determine if a person has a cut, and what kind it might be, based on what it looks like from the outside.


This part is much more difficult at this point...

The science just isn't there yet to allow us to pinpoint the exact causes for a lot of "cuts".

Many, many people are working to figure it out,
approaching the question from all different angles.

But meanwhile, there are a lot of people who can't wait for decades for all of the research to shake out, and need treatment based on what we do know at this point.

So good doctors use the DSM,
up-to-date scientific research,
and what they know about each patient's
medical,
social,
family,
educational,
and developmental
history,
to make their best guesses as to what the problem is, what caused it, and how to make it better.

Prevention of impairment/disability is a tremendously important goal, and knowing the true causes of disorders (including contributions from genetics and family environment) is vital for that effort.

But there are also people who need treatment now, and without having all of the answers, we end up making do with rough guidelines and best guesses and clinical experience and population studies and individual responses.

I agree thanks,

I felt those points but could not include them in my post without confusing the main issue.

I also agree that we don't always know the answers.

The best approach would be to look at each individuals lives separately with their doctors.

And try not to ignore things we do know.

Stress makes things worse.

So the question is what stresses did people experience,

that might of made things worse.


There are reasons why I think emotional pain is important to understand.

In regards to treatment.

People sometimes ask questions around here,

that I think can be answered by looking at the persons life experiences.

And the topics aren't easy.

But holding things in aren't going to help either.

I encourage everyone to talk to their doctors privately about there emotional pain.

Its not your fault.

Thanks

[Fortune]

I've spoken to my therapist at length about emotional pain caused by my impairments. It seems to be a pretty integral part of the process.

[Peripheral]

Originally Posted by Fortune

I've spoken to my therapist at length about emotional pain caused by my impairments. It seems to be a pretty integral part of the process.

Side Note: I don't think the DSM are useless, except on the topic of emotional pain.

I appreciate all the good things that Dr.Barkley and other professional do for me as a person with ADHD.


Thanks Fortune,

Sorry for getting worked up in the other thread.

Love GBYR

[Fortune]

That's because the DSM is not about treatment, but about diagnosis and statistics.

Thanks.

[Peripheral]

Originally Posted by Fortune

That's because the DSM is not about treatment, but about diagnosis and statistics.

Thanks.

Where do you recommend I look for guidelines about ADHD treatment?

[anonymouslyadd]

I think twin studies would be able to shed light on this subject, wouldn't they?