Fear or ADHD

[SkepticLance]

An interesting item in the New Scientist.

Australian printed edition. 16 June 2007, psage 24.

 

Psychologist Rosemary Rowe states that, in young children, the symptoms of ADHD closely resemble the symptoms of a child who is severely frightened. She suggests that a lot of kids are diagnosed wrongly, and put onto drugs, when what they need is reassurance from parents and a good cuddle.

 

Lots of things frighten young children, including scary stories, their own imaginations, and actions of adults.

 

According to Rosemary Rowe, the extreme symptoms of strong fear in young children strongly resemble the symptoms of bipolar disorder, and she notes that those diagnoses jumped from 13 per 100,000 to 73 per 100,000, going from 1996 to 2004.

 

I am not a psychologist, so would like to hear people's views.

[Revenged]

i don't think much of most psychology tbh... i think it's a very artificial way of studying behaviour and i don't believe most of it myself... i think what we have now is the medicalisation of what used to be normal behaviour and the view that quite a lot of GPs and psychiatrists is that people can best be treated by medication... i know enough pharmacology to realise that this is nonsense... but as you can see this by the epidemic of people who take anxiolytics and anti-depressants that i'm probably in a minority view there... for ADHD (in my world this is 'naughty children syndrome') amphetamines are given as a 'treatment'... go figure that one out...

[YT2095]

it`s quite possible (even likely) that some cases have been misdiagnosed for a whole range of reasons, I think it`s important make a clear distinction between Psychology (Clinical) and Psychiatry though.

there`s a whole World of difference!

 

AFAIK, Glider is the one best qualified to give an opinion and view here.

 

my Opinion is that if she right and this is the case, then Excellent! more Data is always useful.

[Glider]

i don't think much of most psychology tbh... i think it's a very artificial way of studying behaviour...

We're always open to suggestions.

 

i think what we have now is the medicalisation of what used to be normal behaviour and the view that quite a lot of GPs and psychiatrists is that people can best be treated by medication... i know enough pharmacology to realise that this is nonsense...

I agree to an extent. There do seem to be 'fad' conditions and ADHD seems to be one of them. It does exist, but as with most things, it exists on a continuum and some GPs (and most parents) are a little hazy as to where the clinical threshold is. As a result, I think many kids who are simply annoying have been wrongly diagnosed. I'm sure that as YT says, there have been many cases of misdiagnosis for many different reasons, but that doesn't mean ADHD doesn't really exist.

 

for ADHD (in my world this is 'naughty children syndrome') amphetamines are given as a 'treatment'... go figure that one out...

In true cases of ADHD, an individual's threshold of stimulation is abnormally high. What this means is that situations/event that would normally stimulate/excite an individual do not, so whilst other kids are stimulated by what's going on, kids with ADHD are bored by it.

 

Everybody needs a certain degree of arousal just to function normally (see the Yerkes - Dodson law), and boredom is a far from trivial condition. Try sitting in a room without music, books, computer, TV or any other form of stimulation for 8 hours. Kids with ADHD exist in a state of chronic and severe boredom (understimulation). Their often destructive and violent behaviour is a perfectly understandable (and even predictable) reaction to that state (so I would disagree with Rosmary Rowe, although I haven't seen her paper yet).

 

Amphetamines are stimulants (as you may know if you have ever tried them). To a normal person, boring things become interesting and people on amphetamines can talk about boring crap for hours. In kids with ADHD amphetamines lower the threshold of stimulation so more stimulation 'gets in'. They remove the chronic boredom and consequently the negative behavioural reaction to the boredom goes away.

 

This is another reason I disagree with Rosmary Rowe. I would predict that giving amphetamines to a kid who's behaviour stems from fear or severe anxiety (which are already states of high arousal) would elicit a whole different reaction.

 

The reality is that in true cases of ADHD, amphetamine based drug intervention works. It might not be the best, but as yet there is nothing better and as I say, if you know of anything more effective, we are always open to suggestions.

[Revenged]

i'm glad you agree with my points glider... my experience of psychology was basically an exercise of blindly quoting what other people found in some studies - and much of these things i could tell you and i thought were obvious... and although some things i found interesting (i thought theory of mind and the sally-ann test for autism was quite impressive) it did seem a lot of copy and paste...

 

btw, i'm not convinced by the idea that children with ADHD are bored and need to be stimulated by drugs to be treated... if that were true, most drug addicts would have ADHD...

 

it`s quite possible (even likely) that some cases have been misdiagnosed for a whole range of reasons, I think it`s important make a clear distinction between Psychology (Clinical) and Psychiatry though.

there`s a whole World of difference!

 

ok, point taking... i think what i have a real issue about is not psychology, it's the fact that medication is being given out like sweets... i would be interested to know why this happens... i don't know whether it's because people go to their doctors and pester them for medication or whether doctors try to medicate just about everyone they can...

[Royston]

The reality is that in true cases of ADHD, amphetamine based drug intervention works. It might not be the best, but as yet there is nothing better and as I say, if you know of anything more effective, we are always open to suggestions.

 

I'd be interested to know the true cases and successfully treated individuals against the number of misdiagnosed who are prescibed amphetamine based drugs, and the long term effects of drugs such as ritalin (on children.) I'm well aware of the long term effects of amphetamine on adults.

 

I also can't understand how it's possible to gauge whether the child is actually 'bored' in certain environments, also wouldn't they have to display the same symptons in 'any' environment for it to warrant the diagnosis of ADHD, how is this threshold quantified...it's not as clear cut as 'my child hears voices.'

 

Has there been any increase in good grades and decrease in unruly behaviour at school, noticable that can be attributed to ADHD being succesfully diagnosed and treated ?

 

What I'm trying to ascertain, is that would it (with all things considered) be better to stop administering drugs such as ritalin, because the symptons are so easily confused with normal child behaviour, and other abnormal child behaviour and that the condition is a lot rarer than is being made out.

 

I'm not meaning to attack it's validity, but I have always been very skeptical of this condition...probably more to do with the publicity and misinformation of the symptons, and history of ritalin (specifically in America.)

 

Sorry if this is slightly off topic.

[Glider]

i'm glad you agree with my points glider... my experience of psychology was basically an exercise of blindly quoting what other people found in some studies - and much of these things i could tell you and i thought were obvious... and although some things i found interesting (i thought theory of mind and the sally-ann test for autism was quite impressive) it did seem a lot of copy and paste...

As with other sciences, the function of Psychology is simply to observe and explain - we observe natural phenomena (in the case of Psychology, human behaviour and cognition) and then try to explain the underlying processes. It is engaging in the observation - theorising - hypothesis testing process that makes the difference between a Psychologist and someone who has read some Psychology.

 

The difference, when it comes to explantations that seem 'obvious', is that a Psychologist will have done the appropriate work and generated some empirical evidence in support of their contention rather trying to suport it with 'well, it's common sense, innit?'. Many of the things that appear 'obvious' only do so once they have been explained. A bit like explaining how a magic trick is done, once someone else has done the work, other will always chime in with "Ohhh...but that's obvious!"

 

btw, i'm not convinced by the idea that children with ADHD are bored and need to be stimulated by drugs to be treated... if that were true, most drug addicts would have ADHD...

That's a dumb thing to say for too many reasons to go into here, but a couple of the more obvious flaws are that: Not all drugs of abuse are stimulants. Not all drug abusers take drugs to remove a negative state, but rather to induce an artifically augmented positive one. Addiction, as defined by the presence of an associated pattern of physiological changes and symptoms of withdrawal, is a condition that in itself is enough to drive the continued use of the drug. ADHD is not necessary.

 

ok, point taking... i think what i have a real issue about is not psychology, it's the fact that medication is being given out like sweets... i would be interested to know why this happens... i don't know whether it's because people go to their doctors and pester them for medication or whether doctors try to medicate just about everyone they can...

It's often due to pressure, of time, of parents, and/or of 'ticking boxes'. GPs did the same thing with antibiotics and fluoxetine and other 'drugs of the moment'. Everybody wants a quck-fix ands GPs are under huge pressure to deliver,even when there is no quick fix solution.

 

I'd be interested to know the true cases and successfully treated individuals against the number of misdiagnosed who are prescibed amphetamine based drugs, and the long term effects of drugs such as ritalin (on children.) I'm well aware of the long term effects of amphetamine on adults.

I don't know the numbers. I'm not sure anyone does, but successfully treated true cases compare very well against untreated true cases. I believe the idea behind treatments such as ritilin is to maintain a low maintenace-dose rather than 'party' bolus doses, and also to limit the period of treatment as much as possible.

 

I also can't understand how it's possible to gauge whether the child is actually 'bored' in certain environments, also wouldn't they have to display the same symptons in 'any' environment for it to warrant the diagnosis of ADHD, how is this threshold quantified...it's not as clear cut as 'my child hears voices.'

As it comes down to low levels of arousal, it's hard to compare environments as people find different environements differently arousing. To some, a trip to a museum is exciting, to others it makes them want to open a vein, so no, the symptoms would not be apparent in 'any' environment.

 

However, there are environments that kids share in common, e.g. school and to a lesser extent (due to variance between families), home. Boredom presents common symptoms, such as the inability to concentrate on a task for even short periods of time, frustration with tasks that demand concentration, hypermania and aggression.

 

Like many psychological conditions, reaching a diagnosis can be tricky and can't be done with a cursory visual examination. It requires a more in-depth investigation that takes time (something very few GPs have much of). Even your example of a 'clear cut' symptom: 'my child hears voices' is not as clear-cut as you seem to think. Of what do you think it is a clear cut example?

 

Has there been any increase in good grades and decrease in unruly behaviour at school, noticable that can be attributed to ADHD being succesfully diagnosed and treated?

Yes. Profound changes in behaviour (reduction in disruptive/agressive/antisocial behaviours) and increased scholarly achievement have all been recorded.

 

What I'm trying to ascertain, is that would it (with all things considered) be better to stop administering drugs such as ritalin, because the symptons are so easily confused with normal child behaviour, and other abnormal child behaviour and that the condition is a lot rarer than is being made out.

No, I don't think so. I believe it would be better to refine the diagnostic process. I believe that drug interventions should absolutely not be dealt out like smarties at the first sign of fractiousness in a child. Tighter controls do need to be in place, but the benefits of correctly treating genuine cases of ADHD are too large to dismiss out of hand.

 

I'm not meaning to attack it's validity, but I have always been very skeptical of this condition...probably more to do with the publicity and misinformation of the symptons, and history of ritalin (specifically in America.)

 

Sorry if this is slightly off topic.

The abuses surrounding the condition (and there are, no doubt, many) have given anything to do with it a bad name, I understand that. Nonetheless, the condition does exist and is treatable. The current treatment may not be the best, but it is effective and until something better is found...(research continues).

 

I suspect that many of the abuses occur because some parents just don't want to put the effort into parenting. If your child is a little difficult at times, it's often easier to get a clinical diagnosis from a sympathetic GP and fill the kid with 'Shut The F**k Up' drugs than to put in the time actually being a parent.

 

Ritalin and other drugs have come under fire, but they're just drugs. The abuse is not in the substance, but in how it's used. Tom Cruise (lunatic scientologist) conducted a diatribe agains psychiatry and chemical interventions in general: "Do you know now ritalin is a street drug?" (see here). Well, diamorphine (heroin) is also a street drug, but it still the best method of controlling the severe pain of terminal cancer known. Abusing a drug does not make the drug wrong, it makes the abuser wrong.

 

Cruise also suggests that scientology is a better solution to things like ADHD and clinical depression than any drug intervention. If people want to go that way, that's fine by me. It might even allow us to do some comparative studies: drug intervention Vs bollocks.

[waitforufo]

My son was having behavior problems in school when he was in the first grade. His teacher suggested I have his pediatrician check him for ADHD. After a physical, the pediatrician thought ADHD was likely, but he wanted the opinion of a Psychiatrist. The Psychiatrist recommended a low dose of Ritalin daily.

 

Now I was willing to follow these instructions, I even went a picked up the medication, but I was still hesitant. So, I called his previous pediatrician from a town we had recently relocated from. The first question he asked was how much sleep does you son get at night? I said about 8 hours a night. He told me that children my son’s age often need at least 12 hours of sleep every night. He said Ritalin was a good treatment for ADHD, but if I wanted to postpone the treatment for a time to see if more sleep helped it wouldn’t be a big deal. He also told me to make sure my son was actually sleeping when in his bedroom.

 

The first night I put him to bed early I checked 2 hours later to make sure he was asleep. Nope. When I asked him why, he said he was cold. So I put some more blankets on his bed. Checked again in an hour and he was fast asleep. After that first night, he slept about 12 hours a night. His sleep time dropped off as he grew older.

 

No more complaints from school. I had him checked again and his Psychiatrist said he no longer had ADHD symptoms.

 

Before my own personal experience, prescribing amphetamines for ADHD made no sense. After that, it made perfect sense.

 

I know my experience is anecdotal. I have however suggested it to four other parents struggling with the same medical decision for there children. Two decided not to medicate after trying more sleep. I believe that I and all of them would have medicated their children had more sleep not worked.

[Royston]

Glider, thanks you've quenched any suspicions I had about the condition itself...which was exactly what I was after. My suspicions arose from the lobbying of American pharmaceutical companies in promoting drugs such as ritalin, and this is where I thought the rather broad range of symptoms stemmed from...you don't get this type of publicity for pharmaceuticals in the UK, as I'm sure you're aware. Your description of the symptoms were far more specific, and this is obviously the crux of the problem in a correct diagnosis.

 

Ritalin and other drugs have come under fire, but they're just drugs. The abuse is not in the substance, but in how it's used.

 

I'm sure I've mentioned this elsewhere on similar topics, and yes I agree.

 

Tom Cruise (lunatic scientologist) conducted a diatribe agains psychiatry and chemical interventions in general: "Do you know now ritalin is a street drug?" (see here). Well' date=' diamorphine (heroin) is also a street drug, but it still the best method of controlling the severe pain of terminal cancer known. Abusing a drug does not make the drug wrong, it makes the abuser wrong.

 

Cruise also suggests that scientology is a better solution to things like ADHD and clinical depression than any drug intervention. If people want to go that way, that's fine by me. It might even allow us to do some comparative studies: drug intervention Vs bollocks.[/quote']

 

Heh, I'm not entirely sure why you brought Tom Cruise into this (I agree his opinion means bunk especially as it's based on a hokey belief system such as Scientology), I've always wondered why any celebrity e.g somebody like Vanessa Phelps feel that their opinion has more weight, just because they're in the public eye. Vanessa was just an example, it holds true for any celebrity tackling issues they're just not qualified to voice opinions on.

[Revenged]

i know that my slagging off of psychology wasn't popular with you glider but bringing scientology into it ... that was a low blow... lol...

 

It might even allow us to do some comparative studies: drug intervention Vs bollocks.

 

I think you'll find that in the studies comparing "anti-depressant" to "congnitive behavioural therapy"... it's CBT that wins vertually every time...

[Glider]

I know my experience is anecdotal. I have however suggested it to four other parents struggling with the same medical decision for there children. Two decided not to medicate after trying more sleep. I believe that I and all of them would have medicated their children had more sleep not worked.

Your experience may be anecdotal, but it is a good example of how easy it is to miss other possible underlying problems. Tired kids are also fractious, have problems concentrating and can be snappy/antisocial. As I say, diagnoses of ADHD can't be done by just observing the behaviour. It takes more in-depth investigation which should include things like diet and sleep patterns.

 

Glider, thanks you've quenched any suspicions I had about the condition itself...which was exactly what I was after. My suspicions arose from the lobbying of American pharmaceutical companies in promoting drugs such as ritalin, and this is where I thought the rather broad range of symptoms stemmed from...you don't get this type of publicity for pharmaceuticals in the UK, as I'm sure you're aware. Your description of the symptoms were far more specific, and this is obviously the crux of the problem in a correct diagnosis.

You're right, pharmacutical companies are not so loud in the UK. They do apply sales pressure to medics and the hospitals are usually full of drug reps, but mainly they're just a good source of freebies (tournequets, pens and so-on), but it's the medics that get to make the decisions based on a solid knowledge base. It's still not a perfect system, but it's better than trying to influence the public directly, as they generally don't have the clinical background required to make an informed opinion.

 

Heh, I'm not entirely sure why you brought Tom Cruise into this (I agree his opinion means bunk especially as it's based on a hokey belief system such as Scientology), I've always wondered why any celebrity e.g somebody like Vanessa Phelps feel that their opinion has more weight, just because they're in the public eye. Vanessa was just an example, it holds true for any celebrity tackling issues they're just not qualified to voice opinions on.

Tom Cruise just kind of popped in there as a good example of an uninformed (or completely misguided) opinion.

 

You're right about the celebrity view that their opinions carry more weight, when in fact, they're just louder. Unfortunately, their opinions do matter to their fans and they do have the power to sway public opinion to a degree (depending on their popularity). Most 'celebrities' (how I hate that term) don't understand the principle of 'Noblesse Oblige' and seem to think that their status gives them the right to hold forth on subjects in which they are not qualified with no thought for the weight their words carry with other people.

 

i know that my slagging off of psychology wasn't popular with you glider but bringing scientology into it ... that was a low blow... lol...

I don't mind people slagging of Psychology as long as they understand what it is they're slagging off. Like all other fields of investigation, )Psychology is not perfect and should always be open to critical evaluation. However, critical evaluation of Psychology is best undertaken by people who know what Psychology is. I thought Tom Cruise was a good example of people who don't and think they have the answers but haven't done the ground work and made sh*t up instead (or bought into a completely spurious belief system) because to them 'it's just common sense, innit?'.

 

I think you'll find that in the studies comparing "anti-depressant" to "congnitive behavioural therapy"... it's CBT that wins vertually every time...

I think you'll find that the most effective treatment is a combination of drug intervention and CBT.

 

Severely depressed people are stultified by their condition. They are not in a position psychologically to engage with a therapist and don't have the energy to take any independant action. Drug therapy as a first-stage intervention alleviates the worst of the symptoms and allows the person to engage and take the action required.

 

CBT is the better therapy in terms of getting to the roots of the problem, and has a very good maintenance record compared to drug therapy alone, which deals with the symptoms only whilst leaving the cognitive behavioural depressive cycle untouched, but it's not an either/or situation, so it's not really appropriate to test one versus the other. Each has a different function and the combination is exremely effective.