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Genetic basis found for ADHD
October 6, 2010 9:16 AM   Subscribe

"Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct." (abstract) Researchers find a genetic basis for ADHD, and the researcher hopes the finding will reduce the stigma associated with the disorder. But maybe it's more complex than just biology. In any case, children who are diagnosed at an early age are 10 times more likely to be depressed as adolescents. (abstract)
posted by desjardins (57 comments total) 24 users marked this as a favorite

 
The really interesting thing to me is that all these copy-number variant errors are on the p arm of chromosome 16. That's the same place that they're finding microdeletions and other DNA variants that correspond to various subtypes of autism. That correlation is tremendously exciting to me.
posted by KathrynT at 9:28 AM on October 6, 2010 [5 favorites]


children who are diagnosed at an early age are 10 times more likely to be depressed as adolescents.

The first question I ask when I read a statement like this is, does the ADHD itself lead to depression, or is it more being labeled so early in life as being somehow incapable of functioning (without ever-present medication) that causes despair and suicide?
posted by hippybear at 9:28 AM on October 6, 2010 [7 favorites]


Kathryn - it sounds like they found a lot of those deletions and dulplications in the control group as well. Do you have any sense if the increase they see is truly significant?

It seems like they had a pretty reasonable control group in the second study.
posted by maryr at 9:34 AM on October 6, 2010


My understanding -- I'm not a geneticist -- is that in the case of the autism studies, they are finding specific deletions that correspond tightly to specific presentations of autism, each of which accounts for fewer than 1% of diagnosed autism cases. So it's a different kind of thing than they're talking about here, where they're finding an increased likelihood of CNVs on 16p in general amongst the affected population. And yeah, to my layman's eye, it does look a significant increase; more to the point, an increase of similar magnitude across two different populations.

It's exciting to me because to the best of my knowledge, this is a lot of genetic material that's been considered "filler DNA," and the fact that these kinds of microerrors associated with two different poorly understood brainy-wainy syndromes are showing up on the same arm of the same chromosome provides a kind of triangulation for further research.
posted by KathrynT at 9:42 AM on October 6, 2010 [3 favorites]


Seems like this is more of a fluffer than a discovery...

kind of like when BBC reported that spicy food was a cure for cancer...

broad scientific discoveries like this have the tendency to become overblown, perhaps by design; there are too many alternative causality factors.


(also, regarding depression, there is no evidence that there is an a priori link between ADHD and deprssion... could not the treatment of any early-childhood psychiatric issue be a casual factor for depression, especially when the treatment is often in the form of strong central nervous system stimulants???)

the suggestion that a medical article can conclude about whether something is or isn't a social construct is laughable. the fact that we are discussing it right now makes it a social construct, regardless of any biological or scientific conclusion.

just remember when looking at studies like this that things overlap. also remember the incentives the medical community has to overlap certain things certain ways.
posted by flyinghamster at 9:45 AM on October 6, 2010


I'd suggest that the issue is that if you're ADD enough to get diagnosed early, you're going to have a really hard time fitting into the little boxes our modern lifestyle wants to force us into. I am ADD as all getout and my old office felt about as conducive to getting work done as a bus station on the day before Thanksgiving. Couple that with a system that is more interested in really dull documents than all the observation and insight in the world.

Speaking of observations, this sort of weirds me out: 'I am saying it's a mixture of genetic and environmental factors, and the important thing is that we don't end up thinking this is a biological problem which is only subject to biological treatments like Ritalin'.

Dude, if you're saying you're trying to change the chemistry inside the brain with a small molecule so, ergo, it's a biological solution, I'd accept that reasoning. But this kind of suggests that your view of the whole mind/brain dichotomy is a lot more esoteric than I want to see in anyone who is giving my advice on what to do with my mind or brain.
posted by Kid Charlemagne at 9:47 AM on October 6, 2010 [3 favorites]


Call me when they find something that has more than an 8% increase in prevalence over controls. This kind of stuff is why brute force biology can be so boring sometimes...
posted by greatgefilte at 9:49 AM on October 6, 2010


the fact that we are discussing it right now makes it a social construct

Don't say that about arterial bleeding to Samuel Johnson. Just sayin'.
posted by Kid Charlemagne at 9:50 AM on October 6, 2010 [1 favorite]


could not the treatment of any early-childhood psychiatric issue be a casual factor for depression, especially when the treatment is often in the form of strong central nervous system stimulants???

This is a good point. They certainly don't mention controlling for treatment in the abstract, although they may have. It's certainly the case that being treated with atypical antipsychotics, for instance, raises your chances of suffering subsequent weight gain, hyperlipidemia, and diabetes. A poorly designed study might conclude that the risk is actually in being psychotic (or in having trouble sleeping, Seroquel is getting prescribed more and more for sleep).
posted by OmieWise at 9:50 AM on October 6, 2010


Kid Charlemagne, I read that as saying that in addition to treatments like Ritalin, there needs to be some environmental treatments as well. Ritalin doesn't magically organize your file drawer.
posted by desjardins at 9:52 AM on October 6, 2010 [1 favorite]


Dude, if you're saying you're trying to change the chemistry inside the brain with a small molecule so, ergo, it's a biological solution, I'd accept that reasoning. But this kind of suggests that your view of the whole mind/brain dichotomy is a lot more esoteric than I want to see in anyone who is giving my advice on what to do with my mind or brain.

I'm not sure what you mean. We know that many non-biological treatments have biological effects, so that even if the "cause" is determined to be largely biological, the treatment need not be. That isn't an esoteric observation, it's well accepted in science and medicine. But perhaps you're saying something else that I can't quite parse.
posted by OmieWise at 9:53 AM on October 6, 2010


When they can find the root of ADHD, maybe that will be the day self-appointed experts will stop telling me I just watched too much TV as a kid, or that if maybe I stopped drinking milk my ADHD would disappear (what), or I ate/eat too much sugar, or that ADHD doesn't actually exist and I'm just lazy/need to get my shit together.

So though I am (understandably) wary of when newspapers interpret medical studies, I am cautiously optimistic about this. But I won't be breaking out the Mission Accomplished banner just yet.
posted by CitrusFreak12 at 9:55 AM on October 6, 2010 [20 favorites]


Neuroskeptic's Take
posted by phrontist at 9:57 AM on October 6, 2010 [5 favorites]


I don't think that the labeling causes the tendency toward depression (or that isn't the biggest factor, at least for me.) I know that I'm my own worst critic, and I know when I'm not doing my best. I know when I'm not paying attention to a loved one and it hurts their feelings (even when they don't verbalize it because they know that I'm trying.)

That takes its toll over time, in my case, to the point of being anxious about it. I'm constantly having to admit to people that I wasn't paying attention and could they repeat that and I'm really sorry but I'm trying really hard, etc. It's embarrassing, and that gets depressing.
posted by schyler523 at 10:23 AM on October 6, 2010 [2 favorites]


Lahey said suicide attempts were relatively rare, noting that more than 80 percent of children with ADHD did not try to commit suicide

Holy crap, what the fuck. Twenty percent of children trying to kill themselves is not okay, nor is it "relatively rare".

Corellation vs. causation flags firmly raised here. Are these children more subject to bullying, do they have abnormal levels of neurotransmitters or neuromodulators as a result of the ADHD, or as a side-effect of ADD medication? This topic needs further study, and a lot of it given the prevalence of the diagnosis today.

Personally, I think it's the meds. Adolescence/puberty is a weird and terrifying experience as it is. Adding psychoactive drugs into the mix (and having those psychoactive drugs wear off partway through the day) didn't help. I got good grades, hated my life, and eventually stopped taking the meds altogether when the other side effects started seriously messing with my overall health. Now I'm a socially-functional underachiever -- I think the tradeoff was well worth it.
posted by schmod at 10:30 AM on October 6, 2010 [2 favorites]


Socializing was always difficult for me as an untreated child/teen/young adult with ADHD, add that to forgetting to brush my teeth (ew), family members and teachers giving me shit constantly for things beyond my control, and yeah, ADHD was a huge psychological burden.

Luckily I had a close group of good friends, I was able to get dates, and I was capable of muddling through with passing grades, but if that weren't the case, I could easily see my life being incredibly shitty as a child/teenager, basically a never-ending progression of social and educational failures.
posted by the young rope-rider at 10:34 AM on October 6, 2010 [1 favorite]


Considering I've been diagnosed with ADD since I was 9 or so, the only time I felt depressed was on Ritalin. Wondering if maybe the depression issues have more to do with the medical remedies and the concept that a young kid is being told "you're not right in the head". Either way, fascinating stuff.
posted by Dark Messiah at 10:36 AM on October 6, 2010


The first question I ask when I read a statement like this is, does the ADHD itself lead to depression, or is it more being labeled so early in life as being somehow incapable of functioning (without ever-present medication) that causes despair and suicide?

I can only answer based on my own experience here. Imagine being told for years how intelligent you are. Imagine having absolutely nothing to show for it. Imagine starting school and dropping out over and over and over again. Every time that student loan bill shows up, you pay it, and have nothing to show for it.
posted by TrialByMedia at 10:37 AM on October 6, 2010 [14 favorites]


Juvenile ADHD diagnosis and on-and-off depression since adolescence here. Shame the stufy isn't better.
posted by Pope Guilty at 10:45 AM on October 6, 2010


This topic needs further study, and a lot of it given the prevalence of the diagnosis today.

As the parent of a possibly ADHD 4 year old, this whole thing terrifies me, because there is just enough information here to be scary without giving enough info to be helpful. Its a hard moment to be in, as a parent, where its sort of clear that there is a diagnosable and fixable problem, but absolutely no agreement on what the right solution (or cause of the issue) might be.
posted by anastasiav at 10:49 AM on October 6, 2010 [1 favorite]


When they can find the root of ADHD, maybe that will be the day self-appointed experts will stop telling me I just watched too much TV as a kid, or that if maybe I stopped drinking milk my ADHD would disappear (what), or I ate/eat too much sugar, or that ADHD doesn't actually exist and I'm just lazy/need to get my shit together.

I think people are likely to do this for almost anything. I regularly get recommendations to try [over-the-counter-pill] or [naturopathic snake oil] when I mention my allergies, despite my assertions that I currently take three prescription medications.
posted by Fleebnork at 10:50 AM on October 6, 2010 [1 favorite]


The neroskeptic link strikes me as extremely insightful for pointing out that ADHD and likely Depression are social constructions. We have a cluster of symptoms that likely have different causes and aggravating factors that end up grouped together as a syndrome.

But we don't really have any evidence to support more than a correlation between the two. I think that correlation is a combination of shared neurological risks, social risks, side effects from treatment, and better detection. Note that the finding isn't "children with ADHD diagnosis become depressed adolescents," it's "ADHD children are diagnosed with depression at a higher rate than expected."
posted by KirkJobSluder at 10:53 AM on October 6, 2010 [2 favorites]


One of the most annoying things about ADHD (and I presume other spectrum disorders) is that you have to hit all the criteria for the diagnosis, but people seem eager to assign the tag even if many of the criteria aren't met. For instance, the mother of my kids was concerned that our son was autistic a few years ago, but I made sure he willingly made eye contact when talking, and he did, so I stopped worrying about it -- and a few years down the road, it's obvious he's not autistic. Meanwhile, she's now concerned that our daughter has ADHD, but our daughter just attended her first soccer class and she had no difficulty paying attention and listening in class, and her kindergarten teacher (three weeks into the school year) says she's very attentive and well-behaved. So ADHD is unlikely at this point, even if she's sometimes overly-silly or fidgety.

So I wonder how many valid ADHD->adolescent depression connections there are, and how many depressed adolescents are depressed because their normal behavior has been misdiagnosed as ADHD.
posted by davejay at 10:59 AM on October 6, 2010


Like the neuroskeptic link pointed out, this isn't a genetic basis for ADHD, ADHD is just a word that describes a basket of symptoms. So, this study found a genetic disease that produces ADHD-like symptoms, but it's got nothing to say about the other 85% of the kids who had ADHD-type symptoms.

It's as if a study came out showing that eating lead chips causes ADHD symptoms - in that case, you don't say "kids that eat lead get ADHD" you say "kids that eat lead get lead poisoning!"
posted by r_nebblesworthII at 11:40 AM on October 6, 2010


Just anecdata here, but a correlation makes perfect sense to me because major mood disorders for some people appear to be a kink in the way the brain processes information. People with major depression and/or anxiety don't just feel bad, they see the world in a way that's irrational from a more objective and/or neurotypical perspective.
posted by KirkJobSluder at 11:56 AM on October 6, 2010


This is a really interesti----

HEY LETS GO RIDE BIKES


HEY THAT'S NOT WHAT ADHD IS LIKE
posted by ocherdraco at 11:57 AM on October 6, 2010 [12 favorites]


ADHD is a bit like having a headache. An analgesic will take away the symptoms but it has nothing to do with the underlying diseases. Right now our medications basically treat the symptoms; but do very little for the underlying diseases. This research is really important because it will help us understand how to better target the underlying problems and perhaps improve outcomes for patients.
posted by humanfont at 12:17 PM on October 6, 2010 [3 favorites]


I know that, between the tabula rasa crowd who would like to believe that everything is socially constructed and the folks who think that a willow switch is lacking, ADHD as a disorder with a physical component is a hard sell.

Yes, ADHD is overdiagnosed. That's why you always hear me beating the CPT/TOVA drum (right behind the Overpopulation Gong) in threads on it. However, the fact that you can see its evidence on the occasional PET scan (too expensive for clinical diagnosis) is pretty impressive, and that the underperforming areas of the brain (which are unsurprisingly right where you would expect them to be) can be more aptly mobilized by a stimulant and, whammo, you at least get some kind of correction (given, admittedly, that Ritalin is more like a sledgehammer than a soft mallet for shaping), it all seems to hang together much better than this social construct stuff. And its startling, after administering so many CPTs, to see quite clearly the difference between a day with meds, a day without meds, and a day with too many meds.

Medication is not without its side effects. You'd have to be a fool to deny it. Absolutely, medication must be matched to the patient. It must be titrated, carefully, and repeatedly as kids gain mass and their brains alter with age. It should never be the sole item. However, it is incredibly helpful in giving an extra push that even patience, coping skills, love, and a well-structured, tailored environment cannot always deliver.

The tradeoffs can be troubling, to say the least. It broke my heart when a young man with whom I had worked for years had to make the choice between a medication that made his Tourette's worse and his ADHD more manageable and a medication that did the reverse. He ultimately decided to deal with the tics so he could at least partially focus. It was not a decision that was easily made, especially for someone who wanted to fit in socially, but he ultimately picked the stimulants because he knew how he worked best and the tests bore it out.
posted by adipocere at 12:36 PM on October 6, 2010 [5 favorites]


A telling item from the "more complex" link in the post:
only 57 of the 366 children with ADHD in the study had the gene variant supposed to cause the disorder.
So it looks as if there are some pretty lofty leaps being made in the journey to the "genetic basis" conclusion.

My take on the nature/nurture debate: it's both, people. Just as both genetics and environment factor into alcoholism, obesity, intelligence, height, VO2 max. . . and pretty much every other complex trait humans exhibit.
posted by richyoung at 1:01 PM on October 6, 2010


KirkJobSluder: [...]a correlation makes perfect sense to me because major mood disorders for some people appear to be a kink in the way the brain processes information. People with major depression and/or anxiety don't just feel bad, they see the world in a way that's irrational from a more objective and/or neurotypical perspective.

While this is true, anecdotally I see the causal chain going mostly the other way. Any depression I've felt in life has been mostly situational and related to education or career difficulties caused by ADD. Also, the severity of my ADD like symptoms appears to be entirely unrelated to my mood, I have issues whether I'm happy or sad (my gut feeling is it's actually worse when I'm happy and/or unstressed).
posted by BrotherCaine at 1:37 PM on October 6, 2010


Yeah, my ADHD symptoms get worse when I'm happy and relaxed which in turn has given me a weird thing where I think oh, yay, I'm happy...well, this is going to end pretty fucking badly! (Less so now that I've been on meds for nearly a year, thank God.)

"Yes, ADHD is overdiagnosed. "

Cite please? They're expanding the criteria in the DSM-V which seems to indicate that it might be underdiagnosed, but I would love to see information otherwise because it's a subject that comes up very frequently.
posted by the young rope-rider at 2:00 PM on October 6, 2010


I wasn't thinking just that ADD might create situations that can aggravate depression. My (very weak and strictly armchair) hypothesis is that some forms of mood disorders and some forms of ADD might share underlying or overlapping perceptual kinks. If you're primed to see the world as negative and/or threatening, problems focusing attention are likely to aggravate that.
posted by KirkJobSluder at 2:17 PM on October 6, 2010


I can't help but wonder if these studies are more about validating the utility of these genetic tests than finding a "cause" for ADHD.

"Look, this stuff really works! Can I get some money now?"
posted by TheLastPsychiatrist at 3:15 PM on October 6, 2010


The problem is that at some level there is a "biological" basis for everything. Sex drive: Clearly a biological basis there.

It does sometimes seem that things that previously would have been considered part of our 'personality' now get pathologized because those personality aspects don't fit in well with modern society. That isn't to say they shouldn't be treated.
posted by delmoi at 4:21 PM on October 6, 2010 [1 favorite]


ADHD is not over diagnosed, if anything it has been my observation that it is poorly understood and under reported. Medicine isn't perfect but for many of us it has been pretty amazing. For example I now remember to turn off the gas range everytime I'm done cooking. Every time. A few milligrams of a controlled substance and a lifetime of "how could you fucking forget to turn off the stove, you could have killed us..." came to an immediate end. No more check
the stove twice before bedtime, and thrice before leaving the house.
posted by humanfont at 5:47 PM on October 6, 2010 [4 favorites]


I'm not sure what you mean. We know that many non-biological treatments have biological effects...

OK, first there's my own bias due to the the world I live in - ritalin is a chemical not a biological. I realize that Daltons are not most people's preferred unit of weight, so please humor me here.

The part that really stuck in my craw, though, is the suggestion that ADD/ADHD is not a biological issue, which to me suggests that he would dismiss a PET scan is an over glorified Ouija Board and that my thalamus is a social construct. Not to go all reductionist here, but my head (where I'm pretty sure I do most of my thinking) is made of meat. If your non-pharmaceutical treatment doesn't have a biological effect, you are selling snake oil. You may believe in your snake oil deep down in your heart, but that doesn't make it not be snake oil.

That being said, I'm all for the notion of behavioral therapy since even with medication I've got 30+ years of bad coping strategies that I find myself fighting with all the time. If I had a kid with ADD/ADHD I would definitely pursue both forms of treatment.
posted by Kid Charlemagne at 6:32 PM on October 6, 2010 [1 favorite]


Also, yeah, exactly what humanfont said. For me the one I'd love to be rid of is a habit of putting things off until the last possible minute so that the fear of impending doom would keep me focused.

Also, looking at delmoi's comment - some experiences I have had that have clued me in to how I am wired relative to everyone else: Leaving something in someone's office while they were there, working on the computer, and their not noticing my presence despite my delicate linebackeresque physique. Making sudden lane changes in traffic to avoid situations that I see forming in the next lane and my passenger kind of freaking out until I explained the "mate in three" move I was trying to avoid. Going from A to I to R to Z in an explanation and people demanding that I go back and fill in all those discreet steps in between, no matter how trivial and dull they seemed to me. From my point of view it seems like maybe these people ought to look into a cat scan or something because how can you not notice when a 6'4" 300 lb. ogre shambles into your office? That's got to be indicative of some kind of terrible neurological disorder.

Meanwhile, they look at me grinding my teeth because I have to get a report done and they mail guy walking by distracts me and the sound of the printer distracts me and "How the hell do you people breath so loud? Jesus!" and come to the conclusion I'm the one with the issue.

Simple democracy says it's me. But I'm going to demand a recount the day after the jackals get loose in the building.
posted by Kid Charlemagne at 7:13 PM on October 6, 2010 [6 favorites]


It was hard for me, as someone who does not have ADHD, to really understand it until my husband was diagnosed (at age 35) and started taking Ritalin. It was like night and day. He really wasn't ignoring me. He really did just forget to do [$chore]. He wasn't being passive-aggressive or lazy. The Ritalin made it crystal clear to me that it was a biological issue. Of course, he still had to learn organizational habits that were not as difficult for me to pick up, but the basic issue is absolutely, observedly biological.

A genetic link does not surprise me either, given that no one in my family has it, and multiple people in his family do.
posted by desjardins at 7:25 PM on October 6, 2010 [1 favorite]


The first question I ask when I read a statement like this is, does the ADHD itself lead to depression, or is it more being labeled so early in life as being somehow incapable of functioning (without ever-present medication) that causes despair and suicide?

It appears that you may have little first-hand experience. In my experience, and in the experience of other sufferers I've read about, it is really, really heartbreaking to feel like a failure even you are perfectly capable and DAMN IT WHY I CAN'T I DO THIS. It should be perfectly possible, but it ends up not being so.

I've been dealing with these problems for over a decade, and I was worried about the label too. But I got to the point where I realized that I was willing to do almost *anything* to actually be able to get stuff done, and labels, meds, or what have you were really a small, small price to pay. Sign me up for that label it it helps! I'm really tired of failing.

And my son is diagnosed, too (that's what got us in there in the first place). He's going to have a label. Just like he has a label of 'asthma'. BFD. The labels mean, "Your body isn't working exactly optimally." Now that we know that, we can mitigate it through various options and compensate in others. Just knowing what to expect is huge.

ADHD as a disorder with a physical component is a hard sell.

Not to me, not anymore. I was dubious. But when our first son was born, he practically *from birth* was always different: never settled down, never relaxed--totally different from his peers and what we expected. He's always been a challenge compared to his siblings (who do not appear to have similar problems).

I don't intend for him (or me) to get a free pass on the things that are hard, the diagnosis just means that we have more work to do in some areas (and, yes, less in others)--and we have the beginnings of where to turn to for coping mechanisms. Because sometimes--yeah, you gotta sit still for an hour because it's rude to disrupt the group--but we can minimize the times we're forced into those situations but train so that they can be successful.
posted by RikiTikiTavi at 7:54 PM on October 6, 2010 [1 favorite]


does the ADHD itself lead to depression, or is it more being labeled so early in life as being somehow incapable of functioning (without ever-present medication) that causes despair and suicide?

As two people who were UNdiagnosed and UNtreated until adulthood, my husband and I can both assure you that the despair is entirely unlinked to anything relating to diagnosis or treatment.

The total inability to DO, however, particularly when it's made into personal blame ("if you'd just apply yourself...")--that's a soul-killer.

The meds are woooonderful. They may have limitations, but oh man oh man oh man...we can DO things.
posted by galadriel at 8:34 PM on October 6, 2010 [3 favorites]


I find it ironic that in a post about, you know, science, the response to legitimate questions regarding that science (that is, to questions that arise from the conduct of that science), is almost all about anecdote. ADHD is not overdiagnosed because X can remember to turn off the stove; the correlation/causality morass is drained because Y was depressed before diagnosis or treatment; ADHD must be biological because Z has seen medications treat it effectively. All of those things may be true, but none of them answer the questions as asked. It's weird when a post that is essentially framed to say "Thank goodness, science has done away with the need to argue from anecdote" becomes an excuse for arguing from anecdote.

I understand that people feel strongly about a diagnosis that may apply to them, but, as the linked paper itself actually makes clear, this research does not tell us anything about the vast majority (~85%) of people diagnosed with ADD/ADHD. There's a lot of work still to do, and there's a lot of disconfirming evidence to be sorted. Just for a start: everybody does better on a little bit of amphetamine. This is something psychiatrists have known, and exploited, for a long time. Concentration improves, test scores go up, mood improves. The fact that people diagnosed with something we call ADD/ADHD do better when on stimulants is entirely predictable and tells us absolutely nothing. People who argue that it does don't understand much about how stimulants work.

None of this is meant to diminish the real distress people with ADD/ADHD experience, nor is it meant to diminish the stories told in this thread and others. Indeed, I understand why, especially in a case where people may have been demeaned based on a lack of diagnosis, it would be important to tell those stories. I just hope we don't confuse those stories with answers to the many questions about ADHD that still need to be answered.
posted by OmieWise at 5:55 AM on October 7, 2010 [1 favorite]


If your non-pharmaceutical treatment doesn't have a biological effect, you are selling snake oil.

Yeah, but my point is that almost everything has a biological effect, and therefore does not count as snake oil. Certainly we know that medications have biological effects, but we also know that placebos have biological effects. We know that talk therapy, and behavior therapy, and exercise, and food, and smells, and sounds, and, well, just the whole damn world, have biological effects. The question is what has efficacy and effectiveness in treatment?
posted by OmieWise at 6:17 AM on October 7, 2010


OmieWise no one has offered any scientific basis for the claim that ADHD is overdiagnosed. Making the claim is as ridiculous as saying, I see a bunch of kids wearing eyeglasses, actually it's just a big conspiracy by the lense makers. Most of those kids would be fine if they just squinted more. I blame the lazy parents who are just using the glasses as a quick fix when we all know it's their fault.
posted by humanfont at 6:39 AM on October 7, 2010 [1 favorite]


OmieWise no one has offered any scientific basis for the claim that ADHD is overdiagnosed.

A statement which does not obviate anything I wrote, especially as I never made the claim. Your own anecdote is particularly strange, since you purport to draw epidemiological conclusions from your own actions in the kitchen. There is at least a plausible question about whether or not ADHD might be overdiagnosed, given the huge increases in diagnosis in the past 20 years, but there is no plausible reason to think it is not overdiagnosed just because you can turn off your stove. Someone, somewhere has the even the rarest disease.

But, this is partly my point: you've got to be careful when you want it both ways, when science is the standard but anecdote is the argument. I'm not trying to be harsh, I'm just commenting on the dynamics at play in the thread.
posted by OmieWise at 7:12 AM on October 7, 2010


My last comment came out much harsher than I intended. This is the trouble with this type of anecdote. It is, by its nature, extremely personal. I'm not interested in belittling or denigrating any of the anecdotes in this thread, nor do I think that any of the other questions in this thread cast doubt on them. But it is hard to have a discussion about these issues when anecdote is the standard, because in addition to being deeply personal, anecdotes are irrefutable.
posted by OmieWise at 7:43 AM on October 7, 2010 [1 favorite]


Well on the contrary, there are legitimate methodologies that look at commonalities across anecdotes, and examination of individual cases is a valid basis for the development of creating hypotheses.

But as pointed out, neither of the studies make a strong case for any of the specific hypotheses discussed here.
posted by KirkJobSluder at 8:17 AM on October 7, 2010


Well on the contrary, there are legitimate methodologies that look at commonalities across anecdotes, and examination of individual cases is a valid basis for the development of creating hypotheses.

Sure there are. But they have nothing whatsoever to do with this thread or with the discussion it contains.
posted by OmieWise at 8:53 AM on October 7, 2010


If your non-pharmaceutical treatment doesn't have a biological effect, you are selling snake oil.

Yeah, but my point is that almost everything has a biological effect, and therefore does not count as snake oil.


Right, but going back to the first thing I said in this, the quoted expert for the dissent sounded like he was specifically trying to cull the notion that ADD/ADHD might be a "biological problem" from the herd. So I'm seeing some kind of fundamental disagreement between you and him. (I'm probably OK with your take on the subject. His, or at least the way his statements were spun in the article, had me thinking, "Here comes the iridology! Brace for impact!")

Also, the problem with measuring ADD in a scientific way is, what do you measure that isn't going to be counfounded with roughly a zillion other things. Is it signifigant that I'm more interested in your shiny new (and therefore stimulating) testing facility than the average subject? Do you measuring how soon I loose interest in it? How fast I go from being interested to disinterested? Is my interest or disinterest a measure of ADD or something else? Does it count as disturbing the system if you have to ask the subjects to stick their heads in a giant magnetic donut while you inject them with some radioactive fluorine?

Animal studies with direct readouts are painful to conduct and generally require large number of subjects to get reasonable confidence. Human studies where there really isn't a direct readout.... You're pretty much going to end up with anecdote.

And then there is the MeFi standard where an r² of 1.000 is just not good enough for some people.
posted by Kid Charlemagne at 12:13 PM on October 7, 2010


There are many studies regarding the myth of over diagnosis. Furthermore the behaviors described anecdotally here have been studied under more rigorous conditions and found to be part of larger behavior patterns of people with ADHD. There are also mountains of clinical trials, peer reviewed publications and studies that demonstrate that these behaviors can be controlled with medication. You contend that I'm not scientifically rigorous yet you seem unwilling to engage in developing basic foundational knowledge necessary to have an intelligent conversation. The problem here isn't anecdotal discussion lacking a scientific foundation, it is your ignorance of the subject matter.

There is at least a plausible question about whether or not ADHD might be overdiagnosed, given the huge increases in diagnosis in the past 20 years, but there is no plausible reason to think it is not overdiagnosed just because you can turn off your stove.

You misunderstand my comment and imply an incorrect association. I made a series of statements regarding ADHD based on personal experience. One of those is that it is under-diagnosed. I did not elaborate or support the observation because I didn't feel the need to. I then provided some additional insights on the efficacy of medication related to a specific behavior pattern.
posted by humanfont at 2:51 PM on October 7, 2010 [1 favorite]


There are also mountains of clinical trials, peer reviewed publications and studies that demonstrate that these behaviors can be controlled with medication. You contend that I'm not scientifically rigorous yet you seem unwilling to engage in developing basic foundational knowledge necessary to have an intelligent conversation.

I have no idea what you're talking about. You may be confusing me with someone else in the thread. It's true, I alluded to your comment in my earlier comment, because I thought it illustrated a tendency seen throughout the thread, but I haven't disagreed with you.

I haven't challenged the diagnosis of ADHD, questioned the efficacy of the medications used to treat it, or disputed any scientific assertion with opinion. Furthermore, I'm broadly conversant with the literature on diagnosis, treatment, effectiveness, and outcomes across many different mental disorders. I also have more than a passing interest in the literature and politics of "genetic markers" research for mental disorders. I'm certainly no expert on ADHD, but I have no idea why you're suggesting that I'm uninterested in the topic.

I suspect that you did not like my comment pointing out the very personal and rapid retreat to anecdote by those in this thread most affected by ADHD. If you examine my posts you may see why I think you're confusing me with someone else.

(Since you keep raising the issue, I will say that my understanding of the current state of the epidemiology is that people (by which I mean epidemiologists) think that ADHD is not systematically overdiagnosed, but is overdiagnosed in certain communities and areas of the country. The link you supplied is not really worth anything, as it's to a pop-med website, and is not subject to peer review. Further, none of the references it cites regarding overdiagnosis appear to have been peer reviewed. However, a quick search of Pubmed turns up a review article in The Journal of Attention Disorders that concludes that ADHD is not overdiagnosed. I'm not at work right now, so I don't have access to the full text, but this is really the kind of paper you want to reference when you're trying to make a scientific case. I'd be happy to send it to you when I get a copy, if you like.)
posted by OmieWise at 4:16 PM on October 7, 2010


Well OmieWise let's review your statements and perhaps you can clarify things bit:

I find it ironic that in a post about, you know, science, the response to legitimate questions regarding that science

Which science and what are the "legitimate questions" that are being raised. Global Warming deniers also talk about their legitimate questions. Stating that the questions are legitimate is a bit like saying people are saying.

Continuing on you stated:

There's a lot of work still to do, and there's a lot of disconfirming evidence to be sorted. Just for a start: everybody does better on a little bit of amphetamine. This is something psychiatrists have known, and exploited, for a long time. Concentration improves, test scores go up, mood improves. The fact that people diagnosed with something we call ADD/ADHD do better when on stimulants is entirely predictable and tells us absolutely nothing.

You seem to be making some big assertions there. Perhaps this isn't intended to read like some scientologist's screed against psychiatry but you can see how it might appear that way.

Finally:
The link you supplied is not really worth anything, as it's to a pop-med website, and is not subject to peer review. Further, none of the references it cites regarding overdiagnosis appear to have been peer reviewed. However, a quick search of Pubmed turns up a review article in The Journal of Attention Disorders that concludes that ADHD is not overdiagnosed. I'm not at work right now, so I don't have access to the full text, but this is really the kind of paper you want to reference when you're trying to make a scientific case. I'd be happy to send it to you when I get a copy, if you like.

One might be inclined to read this as a bit condescending and patronizing. I'm sure though that you were just trying to be supportive in your odd way.
posted by humanfont at 8:21 PM on October 7, 2010


humanfont, I’m not sure why you think it’s appropriate to dismiss my comments by comparison to global warming deniers and Scientologists. None of my comments warrant that, they’ve for the most part been respectful, and I’ve gone out of my way to make it clear that I’m not trying to disparage anyone’s experience or distress. None of my behavior has been worthy of being called, essentially, a concern troll. I do think that you’ve mis-interpreted a couple of my comments, but I also think that I’ve been taking this as part of a larger conversation which it appears to me you aren’t really involved in.

Which science and what are the "legitimate questions" that are being raised.

The specific questions raised in this set of comments concern: 1) the generalizability of this genetics research, which claims to have found markers in ~15% of ADHD cases; and, 2) the respective roles of ADHD itself and medication treatment for ADHD in raising rates of subsequent depression among youth with the diagnosis. Those are questions that I was thinking about, the former largely ignored by the folks really excited by this news, the latter responded to with anecdote after anecdote. (Which is fine in a certain sense, but not very useful in other senses.)

As I thought over specifically what I meant, though, I realized that I was also linking this to an external set of questions that are current in mental public health. Making that link, and assuming that those questions were either relevant here, or even known, was a mistake on my part. (I’m being sincere and not trying to be condescending.) At the same time, the general tenor of some of the comments here was of the “we’ve solved this!” variety of relief, or at least I read them this way. In addition, many of the anecdotes took part in a particularly egregious form of post hoc ergo propter hoc arguing regarding the efficacy of medications that is a particular bugbear of mine. This is particularly true in the case of stimulant meds prescribed for ADHD, since some of the public health questions to which I referred concern the general safety of these medications for young children. The other set of questions to which I refer include: How safe are stimulant medications for young patients, in particular, do they contribute to sudden death rates, and retarded growth rates in this population? What other treatments are appropriate and effective? What environmental factors exacerbate or trigger ADHD? Is ADHD diagnosed appropriately, and how should we address concerns over both under- and over-diagnosis? What do the gender, race, and socioeconomic differences in diagnosis tell us about this disease? I’ve written all these questions in a very general way, but they are specifically addressed in various permutations widely in the literature.

Now, some of those questions are ones that it seems that you might not like. But I’d stress to you that none of these questions are dismissive of ADHD sufferers, or suggest that they’re “lazy” or anything like it. Even saying that ADHD is sometimes over-diagnosed does not suggest that any one person does not have ADHD, does not suffer because of it, and is not in need of treatment. In other words, these are questions that may tangentially touch on the ontology of ADHD, but which are really focused on the epistemology of the disorder. They come with the territory, and, further, the answers are likely to expand the options for sufferers and patients. We know that familial and behavioral interventions work to reduce or eliminate ADHD symptoms, and we should be careful not to artificially limit the array of treatment possibilities when people need more, rather than fewer, ways to live fulfilled lives.

You seem to be making some big assertions there. Perhaps this isn't intended to read like some scientologist's screed against psychiatry but you can see how it might appear that way.

It took me a long time to even parse your objection here, which, in my defense, you don’t really detail. As near as I can get, I think you don’t believe my assertion that everyone does better on a bit of amphetamine, and you think that my use of the word “exploited” signals my true motives as an anti-psychiatrist? If it isn’t those two things that you object to, I have no idea why you’re trying to dismiss my comment by recourse to ad hominem. In the first place, I must admit that it’s been a long time since I’ve looked at the studies, but there are plenty out there. The military has, and still does, routinely used amphetamine to increase or maintain mental acuity in pilots. There are a ton of studies on it. There are also a host of studies available on pubmed that detail increased mental performance in rats and humans following amphetamine use. My comment that “everybody does better on a little amphetamine” is actually a paraphrase of something routinely said by Paul McHugh, who was Chair of Psychiatry for many years at Johns Hopkins. My use of the word “exploited” actually referred to the use of small doses of amphetamine routinely by the generation of post-War psychiatrists in the US. This is my own use of anecdote, since I know a lot of psychiatrists from that generation, and it’s something I’ve discussed with them. I certainly didn’t mean it to tie into Scientology.

One might be inclined to read this as a bit condescending and patronizing. I'm sure though that you were just trying to be supportive in your odd way.

I meant it to be both condescending and helpful. You’ve kind of claimed in your last couple of comments that you’re the scientific one in this conversation, and that I’m somehow bent on, well, I’m not sure what exactly, but essentially that I’m a denialist. On the contrary, I work in public mental health, I’m a clinical social work psychotherapist, and I pay significant attention to research in diagnosis, treatment efficacy, outcome analysis, and mental health epidemiology. You and I may not agree about everything, but my views are well within the mainstream, and indeed, it seems to me that you may not even know where the banks of that stream are. That’s fine, this seems like more of a personal issue for you, and as I’ve said, I have no interest in dismissing that, but while you’ve been laudably upfront about your investments, you haven’t seemed to put much thought into your possible limitations in this discussion. You really revealed yourself, and now I’m not meaning to be condescending, when you linked to the page you did. It demonstrated that you were mostly arguing from assertion, even though you were claiming to be arguing from citation. You also didn’t appear to understand what you had revealed by providing the link you did. As far as I was concerned, you deserved a bit of condescension for that, since your comment was directed at me. On the other hand, I think you’ve got a point, and there is evidence that backs up your point, so I think you should know that when you want to argue about these kinds of things, PubMed is your friend.

My reading of our entire exchange, which you may not agree with, is that you were personally insulted by my comment regarding the use of anecdote in this thread. I can understand that, though I did not mean to insult you. You subsequently seem to have decided that I’m very much something I’m not, and so I’ve addressed your insults to me in that regard. You appear to want the best for yourself and others who suffer from ADHD, and I certainly share that desire. Any questions I’ve asked here, or continue to ask in my various roles within the professions associated with mental health service delivery, are purely an outgrowth of that desire.
posted by OmieWise at 6:15 AM on October 8, 2010 [1 favorite]


You did not mean to insult me and yet you admit to using condescending language. You joined this thread saying, "I find it ironic..." essentially attacking the posters here, but you didn't mean to offend. I find that hard to believe. You must have meant to. If you didn't mean to insult, why did you? Of course you already told us why in your own words, "As far as I was concerned, you deserved a bit of condescension for that..."
posted by humanfont at 2:29 PM on October 8, 2010


Ah, I see what it is, your reading comprehension just isn't very good.
posted by OmieWise at 2:37 PM on October 8, 2010


Now THAT was condescending.
posted by KathrynT at 4:30 PM on October 8, 2010


Yes, yes it was. I tried, though, and it seemed the only thing left.
posted by OmieWise at 5:11 PM on October 8, 2010


Well as long as it makes you feel better.
posted by humanfont at 6:02 PM on October 8, 2010


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