ADHD doesn't exist

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evangelinesmum
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ADHD doesn't exist

Post by evangelinesmum » Fri May 13, 2016 10:17 pm

Was having a chat with my manager the other day and ADHD came up in conversation, I said I think my 4 year old might have mild ADHD, as does my husband. My manager is the deputy of a special school and has been through the Thrive Approach training on attachment but hasn't got any other psych background. From his Thrive training he now thinks ADHD doesn't exist and it's just misdiagnosed attachment issues. I'm not a psychologist but am hoping to be in the not to distant future (got my gbc), so I didn't really have a lot of knowledge at hand to critique his thoughts with but I know his opinion made me feel rather uneasy (thinking my child's behaviour is down to poor attachment). Just wondered what you guys thought about his theory? Is there any basis for this and should this idea be promoted through the Thrive Approach?

Many thanks.

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Re: ADHD doesn't exist

Post by lingua_franca » Sun May 15, 2016 2:08 pm

Children with attachment problems may be very impulsive and have other difficulties commonly associated with ADHD because they have never learned to regulate their emotions and to build up healthy levels of distress tolerance (e.g. understanding that not getting what you want immediately doesn't mean that no one cares about you). If they weren't supported and nurtured in their development and education, they are also more likely to have cognitive difficulties - we aren't born knowing how to be perfectly attentive, after all. But this is not the same as saying that ADHD = attachment difficulties. It sounds as if your manager is making a false extrapolation. It's not as if there is a shortage of children who have specific learning difficulties in spite of attuned parenting, after all.

There are some studies on the relationship between insecure attachment and ADHD that might be interesting for you to read (see Clarke, Ungerer, et al 2002) but the research is relatively small scale, and I've never read any study that makes the claim your manager makes.
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maven
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Re: ADHD doesn't exist

Post by maven » Mon May 16, 2016 10:38 am

Indeed. Dysregulated attachment can impede attention and increase difficulties with executive functioning, but that doesn't mean that other causes of similar presentations no longer exist. Its kind of like saying we know that measles causes a rash, therefore all rashes are measles and there is no such thing as an allergic reaction or eczema.
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FerryGlide
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Re: ADHD doesn't exist

Post by FerryGlide » Mon May 16, 2016 4:05 pm

And apart from anything else, what's going on with your manager's communication skills? How crass can you be? Even if he was right (and he's not) imagine saying that to someone who's just said they think their infant has signs of ADHD! I think your manager probably has ALKIADT syndrome.

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Mikel Arteta
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Re: ADHD doesn't exist

Post by Mikel Arteta » Mon May 16, 2016 9:42 pm

Calm down Ferryglide!

Hugely overdiagnosed in my opinion. When I was an AP the team diagnosed two cases in two and a half years (and had to undiagnose many cases from paediatrics). A diagnosis is convenient for some people. Paediatricians are just as problematic as some psychiatrists. I often see letters with five diagnoses, ridiculous. ASD is flavour of the month at the moment and again, hugely overdiagnosed in my opinion.

ADHD, I don't think it does exist. Just convenient for society and parents and tends to come from a clinician using the medical model, which we know has no place in mental health.
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ell
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Re: ADHD doesn't exist

Post by ell » Mon May 16, 2016 10:27 pm

No, Mikel, Ferryglide does not need to calm down. She is completely right that it is pretty insensitive to suggest to a worried mother that her child's difficulties are due to attachment issues, when that person likely knows next to nothing about her or her child!

That is completely separate to the issue of whether or not ADHD 'exists'.

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miriam
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Re: ADHD doesn't exist

Post by miriam » Mon May 16, 2016 10:38 pm

Well said Ell. And when your opinion goes against the whole of established diagnostic criteria, every study of prevalence, and all current best practise policy documents for the UK and the world, you've got to accept that what you have is your opinion (and a controversial and not evidence based one) rather than fact.

I've been involved in over a thousand ASD assessments, and I can tell you for a fact that it exists and is under rather than overdiagnosed. ADHD again definitely exists in the absence of attachment difficulties, and in the presence of them. Yes ADHD is probably overdiagnosed due to the heavy marketing of the pharmaceutical companies, and the 10% figure in america clearly reeks of disease mongering, but that doesn't mean that at least 1% of the population (and probably closer to 2%) do have genuine specific difficulties with attention/concentration/activity levels/executive functioning - many of them with very good nurturing parents and in the absence of any experience that could be causal.
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Re: ADHD doesn't exist

Post by lingua_franca » Tue May 17, 2016 12:45 am

Mikel Arteta wrote:Calm down Ferryglide!

Hugely overdiagnosed in my opinion. When I was an AP the team diagnosed two cases in two and a half years (and had to undiagnose many cases from paediatrics). A diagnosis is convenient for some people. Paediatricians are just as problematic as some psychiatrists. I often see letters with five diagnoses, ridiculous. ASD is flavour of the month at the moment and again, hugely overdiagnosed in my opinion.

ADHD, I don't think it does exist. Just convenient for society and parents and tends to come from a clinician using the medical model, which we know has no place in mental health.
Anecdotal evidence from your time as an AP doesn't say much about prevalence rates. I don't understand how someone could have doctoral-level training in research methods and still not recognise the problems in extrapolating like this from personal experience. Secondly, it is perfectly possible to understand ADHD from a social rather than medical perspective...and even if you do conceptualise it in a more medicalised way, is that always so bad? It's a pretty huge leap to say that the medical model has no place in mental health, and it's as jarring as the idea that social perspectives have no place in general medicine. I have found that if you get someone who is very harsh on themselves and who sees their difficulties as weaknesses to be pushed past or signs that they have failed in some way, for example, a medical approach may give them the encouragement or even the 'permission' they need to self-care. I am firmly on team community psychology, which is critical of the medical model as a general rule, but I wouldn't hesitate to draw on it if necessary - it's just a conceptual framework, and a framework is what you make of it.

For what it's worth, approaching assessments with the conviction that a particular condition is 'flavour of the month' seems like a very medicalised approach to me, in the most unhelpful sense of that term - it means focusing on diagnostic labels and their distribution over the experiences of the person in the waiting room, to the point where you've already half made up your mind before even seeing them.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
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eponymous85
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Re: ADHD doesn't exist

Post by eponymous85 » Tue May 17, 2016 9:55 am

Mikel Arteta wrote:Calm down Ferryglide!

Hugely overdiagnosed in my opinion. When I was an AP the team diagnosed two cases in two and a half years (and had to undiagnose many cases from paediatrics). A diagnosis is convenient for some people. Paediatricians are just as problematic as some psychiatrists. I often see letters with five diagnoses, ridiculous. ASD is flavour of the month at the moment and again, hugely overdiagnosed in my opinion.

ADHD, I don't think it does exist. Just convenient for society and parents and tends to come from a clinician using the medical model, which we know has no place in mental health.
I was going to pick this apart, but i'm going to go with an immature 'calm down yourself love' and a 'smh'.
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Re: ADHD doesn't exist

Post by Geishawife » Tue May 17, 2016 2:00 pm

eponymous85 wrote:I was going to pick this apart, but i'm going to go with an immature 'calm down yourself love' and a 'smh'
:lol: :lol: :lol: :lol:

secret squirrel
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Re: ADHD doesn't exist

Post by secret squirrel » Tue May 17, 2016 7:01 pm

Whilst the comment from the manager in the original post is clearly something of a logical fallacy, as pointed out by others (not to say hugely insensitive!)- I do think the question itself, "is ADHD a valid diagnosis," is worth debate. I would personally understand the spectrum of difficulties labelled "ADHD" as a cultural construct, rather than a medical diagnosis. Rather than spell out why myself, I will instead quote the very helpful BJP article that debates this argument! http://bjp.rcpsych.org/content/184/1/8

"There are no specific cognitive, metabolic or neurological markers and no medical tests for ADHD. Because of uncertainty about definition, epidemiological studies produce hugely differing prevalence rates: from 0.5% to 26% of children. Despite attempts at standardising criteria, in cross-cultural studies major and significant differences between raters from different countries in the way they rate symptoms of ADHD, as well as major differences in the way children from different cultures are rated for symptoms of ADHD, are apparent. More than 30 neuroimaging studies have been published; however, researchers have yet to compare unmedicated children diagnosed with ADHD with an age-matched control group. Sample sizes in these studies have been small and have produced a variety of inconsistent results. In no study were the brains considered clinically abnormal, nor is it possible to work out whether any differences seen are caused by (rather than being the causes of) different styles of thinking, or are the result of the medication the children had taken. What we end up with is a modern version of the long-discredited ‘ science’ of phrenology. Genetic studies show that ADHD is linked with being male (boys are four to ten times more likely to get this diagnosis in practice) and is associated with the normal genetic variation found with traits such as height. Comorbidity is extremely high, throwing doubt on the specificity of the diagnosis. There are no specific treatments for ADHD, with the most widely debated treatment (methylphenidate) being known to have similar effects on otherwise normal children. There is no established prognosis, and association and cause frequently are confused in the literature. ADHD has generated huge profits for the pharmaceutical industry against a background of poor-quality research, publication bias and payments to some of the top academics in this field. Thus, the mainstream dogma on ADHD is contaminated and misleading ( Timimi, 2002).

To explain the recent rise, to epidemic proportions, of rates of diagnosis of ADHD, a cultural perspective is necessary. The immaturity of children is a biological fact, but the ways in which this immaturity is understood and made meaningful is a fact of culture. In modern Western culture many factors adversely affect the mental health of children and their families. These include loss of extended family support, mother blame (mothers are usually the ones who shoulder responsibility for their children), pressure on schools, a breakdown in the moral authority of adults, parents being put in a double bind on the question of discipline, family life being busy and ‘ hyperactive’, and a market economy value system that emphasises individuality, competitiveness and independence ( Prout & James, 1997). Throw in the profit-dependent pharmaceutical industry and a high-status profession looking for new roles and we have the ideal cultural preconditions for the birth and propagation of the ADHD construct.

Is a medical model of ADHD therapeutically helpful? Quite the opposite; it offers a decontextualised and simplistic idea that leads to all of us – parents, teachers and doctors – disengaging from our social responsibility to raise well-behaved children. We thus become a symptom of the cultural disease we purport to cure. It supports the profit motive of the pharmaceutical industry, which has been accused of helping to create and propagate the notion of ADHD in order to expand its own markets. By acting as agents of social control and stifling diversity in children, we are victimising millions of children and their families by putting children on highly addictive drugs that have no proven long-term benefit ( Timimi, 2002) and have been shown in animal studies to have brain-disabling effects ( Moll et al, 2001; Sproson et al, 2001; Breggin, 2002). By conceptualising problems as medically caused we end up offering interventions (drug and behavioural) that teach ADHD-type behaviour to the child. ADHD causes ‘tunnel vision’ in the system, making it more difficult to think about context, leading to interpersonal issues being marginalised. ADHD scripts a potentially life-long story of disability and deficit, resulting in an attitude of a ‘pill for life’s problems’. We create unnecessary dependence on doctors, discouraging children and their families from engaging their own abilities to solve problems. ADHD is de-skilling for us as a profession as there is minimal skill involved in ticking off a checklist of symptoms and reaching for the prescription pad."

References

↵ Barkley, R. A., Cook, E. H. Jr, Diamond, A., et al. ( 2002) International Consensus Statement on ADHD. Clinical Child and Family Psychology Review, 5, 89– 111.CrossRefMedlineWeb of Science
↵ Breggin, P. ( 2002) The Ritalin Fact Book. Cambridge, MA: Perseus Publishing.
↵ Meltzer, H., Gatward, R., Goodman, R., et al ( 2000) Mental Health of Children and Adolescents in Great Britain. London: Stationery Office.
↵ Moll, G., Hause, S., Ruther, E., et al ( 2001) Early methylphenidate administration to young rats causes a persistent reduction in the density of striatal dopamine transporters. Journal of Child and Adolescent Psychopharmacology, 11, 15– 24.CrossRefMedlineWeb of Science
↵ Prout, A. & James, A. ( 1997) Constructing and Reconstructing Childhood: Contemporary Issues in the Sociological Study of Childhood. London: Falmer Press.
↵ Sayal, K., Taylor, E., Beecham, J., et al ( 2002) Pathways to care in children at risk of attention-deficit deficit hyperactivity disorder. British Journal of Psychiatry, 181, 43– 48.Abstract/FREE Full Text
↵ Schachar, R. & Tannock, R. ( 2002) Syndromes of hyperactivity and attention deficit. In Child and Adolescent Psychiatry (4th edn) (eds M. Rutter & E. Taylor), pp. 399– 418. Oxford: Blackwell.
↵ Sproson, E. J., Chantrey, J., Hollis, C., et al ( 2001) Effect of repeated methylphenidate administration on presynaptic dopamine and behavior in young adult rats. Journal of Psychopharmacology, 15, 67– 75.Abstract/FREE Full Text
↵ Taylor, E., Sandberg, S., Thorley, G., et al ( 1991) The Epidemiology of Childhood Hyperactivity.Maudsley Monograph No. 33. Oxford: Oxford University Press.
↵ Taylor, E., Chadwick, O., Heptinstall, E., et al ( 1996) Hyperactivity and conduct problems as risk factors for adolescent development. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1213– 1226.CrossRefMedlineWeb of Science
↵ Timimi, S. ( 2002) Pathological Child Psychiatry and the Medicalization of Childhood. Hove: Brunner-Routledge.

I think Timimi writes really compellingly about this... If the OP is actually interested in pursuing this further, I think his ideas are really quite accessible as a parent - they're not about blaming parents, but instead locating difficulties within their socialcultural context. He's actually written a whole book for parents ("Mis-Understanding ADHD: The complete guide for parents to alternatives to drugs")

Anyway there's my lazy contribution to what hasn't really yet become a debate.

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Re: ADHD doesn't exist

Post by lingua_franca » Tue May 17, 2016 7:59 pm

It certainly is true that we need to look at ADHD through a critical sociocultural lens...but the same could be said of psychosis, depression, and pretty much anything else. We don't have 'hard' biological markers for most mental health difficulties or even neurodevelopmental conditions (and even in neurological disorders where those markers do exist, critical social perspectives are still needed - Alzheimer's disease is by no means a straightforward uncontested concept just because MRI is involved). Don't get me wrong, I think there are legitimate debates to be had about how we respond to specific learning difficulties and the place of pharmacological treatment. But in my experience, debates that challenge the diagnostic validity of only one particular condition are often out to undermine the legitimacy of people's difficulties, and this article is certainly doing that - it reduces ADHD to a question of bad behaviour with the idea that the diagnosis is causing us to "disengage from our social responsibility to raise well-behaved children." Firstly, ADHD isn't a synonym for behaviour problems any more than it's code for attachment difficulties. Secondly, if a child does have specific difficulties with learning (attention, executive function, etc.) then meeting those needs - which includes naming those needs - will protect against the development of behaviour problems, so I don't see how diagnosing ADHD is automatically an abdication of social responsibility. In some cases it might well be a way to write off children with complex learning and behavioural needs, but again, the same could be said for many diagnostic labels. This doesn't mean that they have no meaning or can't be usefully applied. I don't think the authors really make a solid case here.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Mikel Arteta
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Re: ADHD doesn't exist

Post by Mikel Arteta » Tue May 17, 2016 11:10 pm

SS - thank you for the post, very interesting.

Miriam, you said you know for a 'fact' ASD exists. Along similar lines to SS's post, is there a test that can definitely prove someone has 'ASD'?

Ling, you said this, which I found puzzling:

"We don't have 'hard' biological markers for most mental health difficulties."

Why would you need them? If someone is emotionally distressed and it's having a significant impact upon their life, there are no bio markers needed (their words are enough). I also don't need some standard measure (I don't use them) to tell me how they feel, I'd rather listen, understand and contain than get a person to tick boxes. But use of measures is a completely different debate.

No homework sheets, no manual. Some people with mental health diffculties just need a safe, containing, exploratory therapy space, which I know is effective.

Dementia...completely different in my opinion.

#MHA16
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Re: ADHD doesn't exist

Post by lingua_franca » Wed May 18, 2016 12:26 am

Mikel Arteta wrote:SS - thank you for the post, very interesting.

Miriam, you said you know for a 'fact' ASD exists. Along similar lines to SS's post, is there a test that can definitely prove someone has 'ASD'?

Ling, you said this, which I found puzzling:

"We don't have 'hard' biological markers for most mental health difficulties."

Why would you need them? If someone is emotionally distressed and it's having a significant impact upon their life, there are no bio markers needed (their words are enough). I also don't need some standard measure (I don't use them) to tell me how they feel, I'd rather listen, understand and contain than get a person to tick boxes. But use of measures is a completely different debate.
The opinion piece quoted by Secret Squirrel used the inconclusive nature of MRI scans and other neuroimaging data as proof that ADHD has no diagnostic validity, as though such markers are needed. This is why I made the point that most other mental health difficulties and neurodevelopmental problems can't be pinpointed on an MRI, and yet we don't often see these debates happening over them. Right now it just seems to be sexy and edgy to question the validity of ADHD and autism in particular, possibly because of the place they hold in popular psychology and culture.

You also seem to be buying into this very medicalised approach that emphasises the need for biological evidence when you ask Miriam if there is a test that can 'prove' autism. Of course it's not possible to draw blood and test for ASC in the way you test for anaemia. But again, this does not mean that autism does not exist or lacks validity as a diagnosis - there is a pattern of social and cognitive impairments and differences that can be measured, and identifying them allows us to ensure the person's needs are met accordingly. A psychologically informed response is not necessarily about therapy and talking to people about how they feel: if someone has specific difficulty with reading facial expressions or with certain aspects of language, as is common in autism, then no amount of listening to their feelings is going to help them address those particular problems, because they have a cognitive basis. It's not about box-ticking, it's about recognising the nature of a person's difficulties and responding effectively.

To veer into the territory of anecdote and stereotype myself for a moment, I am autistic, and when reading these seemingly endless validity arguments I often start to think that there needs to be one of us on every psychology team as a bulwark against neurotypical difficulty with logic...
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Mikel Arteta
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Re: ADHD doesn't exist

Post by Mikel Arteta » Wed May 18, 2016 8:49 am

Ling, you'd struggle to find anyone less medicalised than me and you know this from my previous posts, so not sure why you say I 'buy into medicalised approaches' - I never have. I actually found your point (the one I quoted) very medical. If someone sat infront of you in therapy (I'm not sure if you're clinical or academic) and said 'I feel really anxious' why would that need a 'biological marker'? I do a lot of therapy and don't look for 'biological markers'. I deal with normal human feelings in therapy with clients, which the media would have you believe are 'abnormal'

Re: why I asked about a 'test' was in response to Miriam's bold claim that she knew for a 'fact' ASD existed. This sounded like there was no uncertainty around it at all, hence my question.

You're right in saying there can be social and cognitive impairments, but they could be explained by other reasons.

You say people 'questioning' diagnoses want to come across as being 'sexy'...? (can't say I have ever come across this). Or on the other hand it could be health professionals communicating in what they believe in and think it is important to do so.

People are questioning these matters e.g. ADHD as there is doubt and I think this should be debated.

We have different opinions, but there's nothing wrong with that.

And when I was discussing therapy, I wasn't referring to people with ASD, but people who experience complex emotional distress (who don't have ASD).

You said:

"it's about recognising the nature of a person's difficulties and responding effectively."

Completely agree.
Blackbird singing in the dead of night, take these broken wings and learn to fly, all your life
you were only waiting for this moment to arise
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