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  #1  
Old 03-15-13, 12:33 AM
mctavish23 mctavish23 is offline
 

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PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

INTRO TO WTF :

I'm starting this thread, something that I've rarely done over the years,

because I was struck by a point mentioned in another thread with an

irrational premise, that I'd like to expand on; in the hope of trying to help the

other thread's OP get a little closer to some of the answers he seemed to be

seeking. If I'm mistaken in my perception of that quest, then please accept

my apology, as I don't "do" passive-aggressive well; either on the internet, or

in real life. What you see is what you get. I'm Robert, Deal With It.


PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS :


With respect to ADHD and the many comorbid (co-occurring) conditions long

associated with it, the reality is that, just as the symptoms vary with age and

corresponding Developmental Stage, so do the frequency of comorbidities.

For (an evidence based) example, the National Comorbidity Study Replication

(NCS-R), determined, on the whole, ANXIETY DISORDERS to be the # 1 Most

Common Comorbid Condition for Adult ADHD. The MOOD DISORDER category

was # 2 (as a group). The KEY POINT is that ADHD is Primary.


ANXIETY REFERRALS FOR KIDS WITH (PRIMARY) ADHD :

That's not the case with kids, as "Anxiety Disorder" referrals related to ADHD

Concerns, don't display the same "clinical" picture as "true" Anxiety Disorders;

meaning there's little in the way of "classic" phobia's or compulsion's. What

they usually turn out to be, are more closely related to 300.02 Generalized

Anxiety Disorders (GAD); also known as Overanxious Disorder of Childhood.

What does that have to do with my point about the other thread, you ask ?

Because the "anxiety" manifested in these (ADHD related) referrals, is almost

always an artifact of the Psychosocial Stressors (also called Environmental

Stressors, Environmental Disruption, or more commonly, Social Disruption);

resulting from the (associated) impairments in major life activities (i.e., failing

grades, academically and emotionally overwhelmed by falling farther behind in

school, inability to meet parental (and personal) expectations, etc.). When

you also factor in Age and Gender Referencing of (ADHD) symptoms, that's

when it gets even more complicated; as (teen) Girls tend to INTERNALIZE

(ADHD) symptoms, which are then manifested as Anxiety and Depression,

while boys EXTERNALIZE theirs, and display more disinhibited acting out.


OTHER (MORE SEVERE) PSYCHOSOCIAL STRESSORS :

PSYCHOSOCIAL ADVERSITY and ATTACHMENT + PTSD (COMPLEX) TYPE :

INTRO CITY :

This is what struck me as I read through some of the other thread, and this is

what I hope to try and provide some insight on. It may help some of you to

know that there's a major nationwide (US) emphasis on treating childhood

trauma and traumatic grief. To learn more, please check out TFCBT

(Trauma Focused Cognitive Behavioral Therapy). Included in that, is the

emphasis on a more developmentally appropriate Post Traumatic Stress

Disorder (PTSD) diagnostic criteria, that includes children / adolescents. If

you're familiar with the DSM-IV TR diagnosis of 309.81 PTSD, then you know

that the research sample upon which it's based, was comprised of mostly

combat veterans. While there's nothing inherently wrong with that, it fails to

take into account Abuse and Neglect, as well as Natural Disasters, Fires,

Accidents, and other types of Childhood Trauma and Traumatic Grief and

Loss; including Witnessing Violence (in the community), etc. There's a real

need to expand that category, and there appears to be a concerted effort to

do so, although it didn't look like it would be in time for the DSM-V. At least

that's what was presented at the 4 day TFCBT training I attended in April and

May of last year.

That brings me around to the subject of ATTACHMENT, which is a highly

complex problem, requiring specialized training in order to treat it effectively.

When you talk about PSYCHOSOCIAL ADVERSITY (Abuse, Physical + Emotional

Neglect, and other forms of Traumatization), nowhere is the resulting negative

impact more profound than in this area. The only exception I can think of is

Fetal Alcohol Spectrum Disorder (FASD), but that's strictly my opinion.

What I've been able to use as a diagnostic "tool" is to combine everything I

know about all the comorbid conditions that are usually present in such

environments, ranging from drug abuse / chemical dependency, generational

abuse and neglect, and the related impact on parenting and personality

development, basic human survival, as well as socio economic factors, and

pre-, peri,- and post natal care; including Fetal Alcohol Specturm Disorder

(FASD).

Those are just a few, but I think you get the point. Most of those also

include the likelihood of evidence based RISK FACTORS, associated with a

(biological) FAMILY / EXTENDED FAMILY HISTORY (on BOTH sides) for both

Undiagnosed and Untreated ADHD, including :

1) ADHD Diagnoses, (with or without meds);
2) Quitting or Dropping Out of School (even if they went back);
3) Criminal Justice System Involvement (including Juvenile);
4) Employment Difficulties (quitting or changing jobs, getting fired);
5) Academic Struggles (with or without special education);
6) Chemical Dependency Diagnoses (with or without treatment);
7) Speeding Tickets, a single DWI/DUI, License Suspensions, Accidents;
8) "Accident Prone" Behavior;
9) Poor Time Management and Procrastination.

There's several more, but I think you get the drift; as those are things that

happen within families/ extended families, with undiagnosed or untreated

ADHD, and are separated from random chance, 93x's /100 (93rd percentile).


ADOPTION :

That is the proverbial "Pandora's Box" of Mental Health, as there's often no

way to really know what's happened. I also realize that was mentioned in the

other thread as well. The only thing I can add here is that the more

information that can be (eventually) tracked down, if at all possible, the more

"puzzel pieces" that can be added to the "clinical picture."


CONCLUSION :

Like anything else, this wasn't meant to be "all inclusive," but I do sincerely

hope it was helpful in some way. Thank you for taking the time to read it.

tc

mctavish23

(Robert)

Last edited by mctavish23; 03-15-13 at 12:46 AM..
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  #2  
Old 03-15-13, 04:30 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
Originally Posted by mctavish23 View Post
The KEY POINT is that ADHD is Primary.

Exactly.

Attention deficit/surfeit is primary and given an adverse psychosocial environment - the disorder is 'fired' off.

The problem with the definition of psychosocial environment (stressful environment) comes from a defintion of ADDers as stress sensitive.

And so - a 'lesser' pyschosocial environment will kick off disorder in ADDer versus nonADDer.

So - if we imagine somebody being poked with a stick.

The stick which does not hurt nonADDer (in play) will hurt ADDer (in play) - resulting in the ADDer reacting as if s/he's been attacked, whereas the nonADDer 'll see the interaction as a game.

With psychosocial factors - it's the stress which these cause - where increased sensitivity to stress (ie stress) is the pre-condition for the precursor characteristic of attention deficit/surfeit to turn into disorder.

-*-

If we take the ADDer and nonADDer in a school environment - the ADDer and nonADDer could well be experiencing the same absolute levels of stress - the same stress hormone production
... ... the point I'm making is that the stress sensitivity in ADDer entails that less stress relative to nonADDer is required to fire off our/the ADDer's stress reaction.

Stress sensitivity.

Based on an optimal other (ketogenic) metabolism which represents our core difference.
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  #3  
Old 03-15-13, 04:34 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Attention deficit (inherited via a mechanism which requires the genome to be changed) <- selected for by stress also (can be considered good/manageable stress)
under
stress [eg psychosocial adversity where not much is required because we're cortisol sensitive] <- can be considered bad/unmanageable stress
leads to
Attention deficit disorder

-*-

Just stress sensitivity which results in the disorder element in ADHD.

Place any ADDer away from stress (almost impossible in this world) and the disorder (eventually) will dissipate but the attentional difference will remain.
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Last edited by SB_UK; 03-15-13 at 04:58 AM..
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  #4  
Old 03-15-13, 04:53 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
Originally Posted by _ View Post
Attention deficit (inherited via a mechanism which requires the genome to be changed)
under
stress [eg psychosocial adversity where not much is required because we're cortisol sensitive]
leads to
Attention deficit disorder
eg

10 foot tall
under
6 foot ceilings
leads to
disorder (back pain etc ... ..)
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Old 03-15-13, 04:58 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Nice presentation and well put Sir! Salt of the earth you are!
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Old 03-15-13, 05:01 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

The sole trick to understanding ADHD is that our advantage is a profound disadvantage in our current hierarchical societal infrastructure.

We're hyper sensitive to psychological stress - are though - relatively immune to physiological stress (low food availability).

Personal experience - definitely true.
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  #7  
Old 03-15-13, 05:06 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
Originally Posted by mctavish23 View Post
INTRO TO WTF :

I'm starting this thread, something that I've rarely done over the years,

because I was struck by a point mentioned in another thread with an

irrational premise, that I'd like to expand on; in the hope of trying to help the

other thread's OP get a little closer to some of the answers he seemed to be

seeking. If I'm mistaken in my perception of that quest, then please accept

my apology, as I don't "do" passive-aggressive well; either on the internet, or

in real life. What you see is what you get. I'm Robert, Deal With It.


PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS :


With respect to ADHD and the many comorbid (co-occurring) conditions long

associated with it, the reality is that, just as the symptoms vary with age and

corresponding Developmental Stage, so do the frequency of comorbidities.

For (an evidence based) example, the National Comorbidity Study Replication

(NCS-R), determined, on the whole, ANXIETY DISORDERS to be the # 1 Most

Common Comorbid Condition for Adult ADHD. The MOOD DISORDER category

was # 2 (as a group). The KEY POINT is that ADHD is Primary.


ANXIETY REFERRALS FOR KIDS WITH (PRIMARY) ADHD :

That's not the case with kids, as "Anxiety Disorder" referrals related to ADHD

Concerns, don't display the same "clinical" picture as "true" Anxiety Disorders;

meaning there's little in the way of "classic" phobia's or compulsion's. What

they usually turn out to be, are more closely related to 300.02 Generalized

Anxiety Disorders (GAD); also known as Overanxious Disorder of Childhood.

What does that have to do with my point about the other thread, you ask ?

Because the "anxiety" manifested in these (ADHD related) referrals, is almost

always an artifact of the Psychosocial Stressors (also called Environmental

Stressors, Environmental Disruption, or more commonly, Social Disruption);

resulting from the (associated) impairments in major life activities (i.e., failing

grades, academically and emotionally overwhelmed by falling farther behind in

school, inability to meet parental (and personal) expectations, etc.). When

you also factor in Age and Gender Referencing of (ADHD) symptoms, that's

when it gets even more complicated; as (teen) Girls tend to INTERNALIZE

(ADHD) symptoms, which are then manifested as Anxiety and Depression,

while boys EXTERNALIZE theirs, and display more disinhibited acting out.


OTHER (MORE SEVERE) PSYCHOSOCIAL STRESSORS :

PSYCHOSOCIAL ADVERSITY and ATTACHMENT + PTSD (COMPLEX) TYPE :

INTRO CITY :

This is what struck me as I read through some of the other thread, and this is

what I hope to try and provide some insight on. It may help some of you to

know that there's a major nationwide (US) emphasis on treating childhood

trauma and traumatic grief. To learn more, please check out TFCBT

(Trauma Focused Cognitive Behavioral Therapy). Included in that, is the

emphasis on a more developmentally appropriate Post Traumatic Stress

Disorder (PTSD) diagnostic criteria, that includes children / adolescents. If

you're familiar with the DSM-IV TR diagnosis of 309.81 PTSD, then you know

that the research sample upon which it's based, was comprised of mostly

combat veterans. While there's nothing inherently wrong with that, it fails to

take into account Abuse and Neglect, as well as Natural Disasters, Fires,

Accidents, and other types of Childhood Trauma and Traumatic Grief and

Loss; including Witnessing Violence (in the community), etc. There's a real

need to expand that category, and there appears to be a concerted effort to

do so, although it didn't look like it would be in time for the DSM-V. At least

that's what was presented at the 4 day TFCBT training I attended in April and

May of last year.

That brings me around to the subject of ATTACHMENT, which is a highly

complex problem, requiring specialized training in order to treat it effectively.

When you talk about PSYCHOSOCIAL ADVERSITY (Abuse, Physical + Emotional

Neglect, and other forms of Traumatization), nowhere is the resulting negative

impact more profound than in this area. The only exception I can think of is

Fetal Alcohol Spectrum Disorder (FASD), but that's strictly my opinion.

What I've been able to use as a diagnostic "tool" is to combine everything I

know about all the comorbid conditions that are usually present in such

environments, ranging from drug abuse / chemical dependency, generational

abuse and neglect, and the related impact on parenting and personality

development, basic human survival, as well as socio economic factors, and

pre-, peri,- and post natal care; including Fetal Alcohol Specturm Disorder

(FASD).

Those are just a few, but I think you get the point. Most of those also

include the likelihood of evidence based RISK FACTORS, associated with a

(biological) FAMILY / EXTENDED FAMILY HISTORY (on BOTH sides) for both

Undiagnosed and Untreated ADHD, including :

1) ADHD Diagnoses, (with or without meds);
2) Quitting or Dropping Out of School (even if they went back);
3) Criminal Justice System Involvement (including Juvenile);
4) Employment Difficulties (quitting or changing jobs, getting fired);
5) Academic Struggles (with or without special education);
6) Chemical Dependency Diagnoses (with or without treatment);
7) Speeding Tickets, a single DWI/DUI, License Suspensions, Accidents;
8) "Accident Prone" Behavior;
9) Poor Time Management and Procrastination.

There's several more, but I think you get the drift; as those are things that

happen within families/ extended families, with undiagnosed or untreated

ADHD, and are separated from random chance, 93x's /100 (93rd percentile).


ADOPTION :

That is the proverbial "Pandora's Box" of Mental Health, as there's often no

way to really know what's happened. I also realize that was mentioned in the

other thread as well. The only thing I can add here is that the more

information that can be (eventually) tracked down, if at all possible, the more

"puzzel pieces" that can be added to the "clinical picture."


CONCLUSION :

Like anything else, this wasn't meant to be "all inclusive," but I do sincerely

hope it was helpful in some way. Thank you for taking the time to read it.

tc

mctavish23

(Robert)

Everything written in this summary is consistent with the idea that ADHD is simply stress hormone sensitivity.
__________________
... ... and so in Conclusion
ADHD [== sensitivity at empathic, systematizing and sensory levels] represents the pained emergence of a social species in an anti-social environment.
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  #8  
Old 03-15-13, 05:10 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Barliman has made the connection between ADD and the highly sensitive person.

http://en.wikipedia.org/wiki/Highly_sensitive_person
It posits that [a list of disorders which afflict ADDers] depend entirely on environmental stressors.

The Highly_sensitive_person (ADDer) is simply 'genetically/epigenetically/epigenomically' sensitive to stress hormone.

The reason for this sensitivity is metabolic in nature.
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ADHD [== sensitivity at empathic, systematizing and sensory levels] represents the pained emergence of a social species in an anti-social environment.
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  #9  
Old 03-15-13, 06:14 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

The basic idea is that stress (just everybody working synchronously) to stress 'you' out will result in epigenetic remodelling of the genome/epigenome into more efficient form.

It's the human equivalent of spontaneous mutation in eg HIV on exposure to adversity (stress) (anti-retroviral).

It's all that the human body can do in response to stress.

Stop the body needing calories - because that's the only stress (stress-relief mechanism) which has been in place during the evolutionary trajectory of life from first principles.

The only evolutionary character which will select is the need for reduced calories - it (at least ordinarily) confers tremendous increased likelihood of survival in a world without food.

Sadly though - it renders us psychological stress sensitive.

It makes us more resistant to the archetypic physiological stress (no food) but makes us more sensitive to psychological stress.

As simple as that.
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  #10  
Old 03-15-13, 11:04 AM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
INTRO TO WTF :

I'm starting this thread, something that I've rarely done over the years,

because I was struck by a point mentioned in another thread with an

irrational premise, that I'd like to expand on; in the hope of trying to help the

other thread's OP get a little closer to some of the answers he seemed to be

seeking. If I'm mistaken in my perception of that quest, then please accept

my apology, as I don't "do" passive-aggressive well; either on the internet, or

in real life. What you see is what you get. I'm Robert, Deal With It. -Mctavish23


Mctavish23

In your opinion, what would that so called irrational premise be?

For clarification?
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Old 03-15-13, 01:00 PM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
Originally Posted by SB_UK View Post
The sole trick to understanding ADHD is that our advantage is a profound disadvantage in our current hierarchical societal infrastructure.
mctavish's entire point, I thought, was to illustrate that there was no "sole trick," and that ADHD, stress, and comorbid conditions is a multifaceted and highly nuanced set of internal and external influences.
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Old 03-15-13, 01:02 PM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Quote:
Originally Posted by Amtram View Post
mctavish's entire point, I thought, was to illustrate that there was no "sole trick," and that ADHD, stress, and comorbid conditions is a multifaceted and highly nuanced set of internal and external influences.
Everything in McT's post makes sense - all compatible with just simple stress sensitivity as the root to ADHD.

All over the Internet are connections between ADHD and 'The highly sensitive person'
- it's going to look really bad if people generally solve ADHD before the paid experts.

Barliman has 2 threads on this subject in science forum.
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  #13  
Old 03-15-13, 01:11 PM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

Thank you Robert! A very interesting read, and written in language that I could
actually read and understand.

Interesting about how anxiety seems to differ between children and adults.
My own anxiety seems more like what you've described in children. Maybe
that's a result of delayed development?
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Old 03-15-13, 08:49 PM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

ty all

SB, as always it's good to see you man.

tc

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Old 03-15-13, 08:54 PM
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Re: PSYCHOSOCIAL STRESSORS and COMORBID CONDITIONS

I've already clarified it twice, and it's NOT "so called," it IS irrational.

The Twin Studies, like it or not, are THE accepted standard, when it comes to the

current science behind the disorder, on the environmental impact of ADHD. Rejecting

them at the outset is irrational.

I hope you got more out of my post than just that, because I went to a lot of trouble

to try and help answer your question; or at least I tried. I also hope you take the time to

look further into some of the psychosocial stressors listed, and how they may (or may not)

apply to your situation.


tc

mctavish23

(Robert)

Last edited by mctavish23; 03-15-13 at 09:24 PM..
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