Is ADHD A Real Disorder? Flashcards
What are the 6 main arguments for ADHD as a real disorder?
1) ADHD satisfies the requirements of abnormality/clinical significance
2) Process of diagnosing ADHD is thorough, reliable, and accurate
3) Growing body of literature consistently shows physiological, neurological, and genetic differences in individuals with ADHD
4) ADHD treatments are safe and effective
5) Individuals with untreated ADHD show poor outcomes in various aspects of their lives
6) The idea that ADHD prevalence has been increasing is a misconception
What are the supporting points for the argument that ADHD satisfies requirements for abnormality?
1) Impairment
- deficit in behavioural inhibition resulting in an inability to focus, hyperactivity, increased impulsive/risky behaviour
2) Distress
- failed academic achievement/work/relationships
- lower self esteem
- poor outcomes
3) Identifiable dysfunction
- engage in more risky/impulsive behaviours results in 4x as many motor-vehicle accidents and 33% increase in emergency room visits
4) Socially and Culturally unacceptable behaviour
- diagnosis requires parents/caregivers and teachers to assess whether the behaviour is:
+ continuous or temporary
+ excessive in comparison to peers
+ significantly different from peers
+ situational or pervasive
What are the supporting points for the argument that diagnosis is accurate and reliable?
- Best practice is multi-method, multi-format assessments
+ Symptom rating scales
+ Subscale of broadband measures
+ Structured interviews
+ Measures of impairment
+ Observational measures (clinical and natural settings, code presence of behaviours)
+ Report cards
+ Teachers, parents, self-report (adolescents), others - Scales can also yield reliable diagnosis
+ meta-analysis of commonly used behavioural rating scales found sensitivities of 72-83% and pooled specificities of 73-84%
What is the prevalence of ADHD?
- DSM4: 6.7% - 7.8% of children
- 2% lower in Europe
- DSM5 is more inclusive -> higher prevelance
What are the four trajectories of ADHD severity?
- persisting low
- quickly remitting
- gradually remitting
- persisting
How are the diagnostic criteria for adults with ADHD?
- Symptoms must be present before age 12: retrospective self-reporting, report cards, collateral report
- Must include performance and symptom validity measures for adults
What are the supporting points for neurological/physiological abnormalities in ADHD?
- Brain imaging for abnormalities
+ delay in cortical maturation
+ dysfunction of prefrontal-striata circuitry
+ frontal-parietal cortical connections - Genetics
+ heritability estimated at 76%
+ multiple genes together mediate vulnerability
+ possible interaction of genes and environment (understudied) - Prenatal/environmental exposure to toxins
+ smoking during pregnancy
+ complications (preeclampsia, UTI, early term delivery)
+ alcohol use during pregnancy
+ lead exposure
What are the supporting points for the argument that treatments are safe and effective?
- Pharmacological
+ psychostimulants block reuptake and trigger release of dopamine and norepi, maintaining alertness, increasing focus, and sustaining thought, effort, motivation
+ meta-analysis demonstrated significant improvement in symptom severity compared to placebo
+ methylphenidate -> significant reduction in symptoms of inattention and hyperactivity (relevance of dopamine)
+ use does not influence substance use disorder, and may even decrease risk - Non-pharma options
+ CBT
What are the points supporting the argument that untreated ADHD leads to poor outcomes?
- low self-esteem and imposter complex
- tend to quit, change jobs, be fired more often
- higher absenteeism and lower productivity
- lower academic achievement -> lower SES opportunity
- impacts on family
What are the points supporting the argument of the stability of true prevalence rates?
- alleged increase in prevalence not supported by empirical evidence
- year of study was not significantly associated with prevalence rate
- studies that have found increases over time have tracked:
+ self-reports of whether children have been diagnosed
+ medication prescription
What are the 4 main arguments that ADHD is not a real disorder?
1) The diagnosis of ADHD was established out of self-interest
2) Symptoms pathologies normal childhood behaviour
3) Mis-diagnosis and psychostimulant prescription have personal costs
4) Psychostimulant prescription has societal costs
What are the supporting points for the argument that ADHD is driven by self-interest?
- In 1980 psychiatry had a bad reputation due to eugenics/holocaust, lobotomies, electro-shock, lack of credibility due to failure of psychotherapy and ADHD was a way to re-assert psychiatrists as real medical doctors (biological disorder with biological cure)
- pharmaceutical industry benefits (money, and donating to CHADD to get more customers)
- teachers get to medicate children to make them easier to manage and dissociate responsibility for not being able to teach adequately
- school counsellors get more authority and increased professional role
- schools get more money for special education
- parents are absolved of failures and excused from making different parenting choices and children are easier to manage
- children get lowered expectations and more time on exams, as well as school accommodations
What are the supporting points for the argument that symptoms pathologize normal childhood behaviour?
- inattention, hyperactivity, and impulsivity are all normal childhood experiences
+ however, symptoms must actually be inconsistent with developmental level, interfere with functioning, and be present in 2 or more settings - diagnosis can be made based on DSM5 by anyone
+ this is totally exaggerating: assessment and diagnosis of ADHD controlled by Regulated Health Professions Act, and physicians can only practice in areas of medicine in which they are experienced and knowledgeable
+ however, there is a lack of clarity in Canada over who can assess and diagnose ADHD
What are the points supporting the argument that there is a personal cost to mis-diagnosis and over-prescription?
- labelling theory
- underlying medical issue might never be addressed
- diagnosis may undermine insurance claims (credibility questioned)
- medications interfere with development, coping skills
- side effects of medication
What are the points supporting the societal costs of ADHD diagnosis?
- Orwellian social control through drugs
- medicating children -> loss in creative potential
+ in drawing test, children on Ritalin had lower levels of creativity as measured by the creativity index (fluency, originality, elaboration abstractness of titles, resistance to premature closure, creative strengths)
+ lower fluency, originality, presence of creative strengths
