Tuesday, May 26, 2009

Attention Deficit Hyperactivity Disorder

First of all I would like to thank those who have kindly inquired about my health following the bike accident. It was not my accident but unfortunatley happened to one of my colleauges here. It sounds like a harrowing experience and I am glad there were no serious injuries.

I have been asked by a reader to do another didactic series so I decided I would wade into the often controversial subject of Attention Deficit Hyperactivity Disorder (ADHD). It is controversial because it involves different ideas about the causes of behavioral problems as well as the use of psychotropic medication in children. This is further complicated by the reality that pharmaceutical companies make a lot of money from ADHD medications. I will say that I think this debate like many others is too polarized and often doesn't take into account that reality is often more complicated than our dogmatic assertions. In my opinion ADHD exists, and there is both under and overdiagnosis of the condition as well as both underutilization and over utilization of pyschotropic medication in children.

As I have discussed before most psychiatric diagnoses are phenomenologically based. That is they are based upon signs and symptoms. There are as yet no laboratory tests to confirm a diagnosis. This leads to the charge by some that psychiatric diagnoses are too subjective. However phenomenologic diagnoses have been helpful in the history of medicine and remain useful in some other conditions such as migraine and epilepsy. With this type of diagnosis the more severe the symptoms present the more likelihood that we are dealing with a common entity and the more mild the symptoms the more likely we are dealing with a behavior spectrum that ranges from moderate to normal behavior. This is further complicated in children in that the younger the child the more limited the repitiore of behavioral expression. An infant crying can mean many things and a six or seven year old child's behavioral problems can result from many causes all of which look very similar in this age grouop. As we grow to maturity we develop a wider range of ways in which to express internal distress. So in ADHD greater the severity of symptoms results in a greater likelihood that we are dealing with an actual entity and the milder the symptoms results in greater likelihood that we are seeing is behavior on a spectrum of problematic to normal varience.

Tomorrow I will define and describe Attention Deficit Hyperactivity Disorder. One thing is clear. This disorder is not one made up by the pharmaceutical companies. There are classic descriptions of this disorder dating back to the 19th century and early twentieth century long before there were any medication treatments available.

Thought for the day

"It is possible not only not to be angry with the insensitive and ungrateful but even to care for them".

Marcus Aurelius

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