Athlon,
I agree with a lot of what you've said. I'm sure that as a teacher, you have a lot of experience with these issues. I will disagree with a few points, however, as recent published research have given us new insights into ADHD.
athon said:
A very simple question that, unfortunately, is after a very complicated answer.
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are two subsidaries of a disorder psychologists call 'Autism Spectrum Disorder' (ASD). It also includes Asperger's Syndrome.
Personally, I would have problems lumping ADHD together with Pervasive Developmental Disorders (or Autism Spectrum Disorders), such as Autism and Asperger's. I know that some professionals do, but I prefer to reserve the PDD designation to entities that have a prominent developmental delay component. Although patients with ADHD can have developmental delay, I find that most ADHD children have normal psychomotor development, despite their learning difficulties.
The problem is, we as a society have grown used to hearing the names of various disorders and thinking of them like they're diseases. 'I've got ADD' is something like saying 'I've got measles', or 'I've got a broken bone'. We're not used to understanding things like ADD or ASD as something that describes a trait, like 'I've got hair darker than other people's', or 'I carry more body fat'.
It's more useful to see these as traits rather than disorders. Afterall, a condition a person has is simply a variation of a trait that is not as efficient as other forms in a given environment. 'Efficiency' is often arguable, and the environment (with humans, at least) is easily variable itself. Hence the classroom is an environment a lot of ADHD kids find difficult to cope with.
I'll agree to a certain extent. It is true that normal people do have problems with attention, and it makes sense to view the ADHD phenomena as the extreme end of a normal trait. Recent studies, however, do suggest that there is a true pathological basis of ADHD, and currently, I would be against classifying ADHD a trait, rather than as a disease. Please see below for further elaboration.
Put them into an environment with multiple stimulations, and they can often excel. Asperger's kids are typically rather creative in certain environments.
That is true. However, as I stated before, ADHD is not really related to Asperger's. In fact, one of the requirements for diagnosing ADHD is that they have difficulties in multiple environments, not just at school. If a child were having attention problems related to only school, I would suspect either specific learning disorders or social problems before ADHD.
(SNIP).... This is why diagnosis is so tricky. There's no clear definition or marker, as it's a scale of a human variation. A bit like asking when blonde hair becomes brown. When does a lack of ability to remain focussed become ADD? When does the fidgeting become ADHD? It is such a complicated trait (dealing with human psychology and sociology) that pinning it down is hard.
I agree wholeheartedly. Diagnosing ADHD from normal behavior is very difficult. Furthermore, most psychologists, psychiatrists, and neurologists do not have enough time to properly diagnose it, as that would involve mutiple evaluations lasting hours at the least.
A lot of negativity has come out of this inability for psychologists to be able to agree on what it is exactly. Remember, we're used to 'one cause / one disease' type thinking.
Secondly, there is no clue as to what might be the root cause. A lot of people diagnosed with ADHD have common results in some brain scans;
http://www.add.org/articles/causeadd.html
But interpreting this with meaning still proves difficult. All it shows, again, is that it is a scale variation in how the brain works. In addition, while some recent studies suggest certain novel food additives and allergens might play a role, there's nothing concrete as of yet. In short, we still don't know much at all.
Recently, there have been multiple studies delineating what exactly is different in ADHD patients. Many studies, in particular one from Mostofsky et al (2002), found that the total cerebral volume is reduced in ADHD children (compared to control). In particular, the frontal lobes are reduced, which control behavior and self-regulation. Castellanos et al (2002) also found that the right hemisphere is smaller in ADHD children. The right hemisphere is involved in regulating attention, which is notably awry in ADHD.
This is why most neurological and psychiatric professionals have problems classifying ADHD as normal. There is simply too much evidence that there is a biological basis. Furthermore, there has been evidence that some of the pathophysiology behind ADHD is from deficient neurotransmitters. In particular, dopamine and norepinephrine have been implicated. Dopamine is involved in working memory, learning, and emotion. Norepinephrine is involved in maintaining attention and alertness.
As for food additive, allergens, etc... I personally have not seen a lot of evidence for this.
A final point regarding Ritalin and other psychostimulant medications: The theory behind the use of these meds is not for the stimulant or metabolic effect, per se. Ritalin et al increase the amount of dopamine and norepinephrine in the central nervous system. A new medication, in fact, (Strattera) has no stimulant effect, but increases dopamine and norepinephrine levels. It has shown early positive results after being placed on the market, and I have professionally had some good results with it.
