A rash of ADHD diagnoses…
January 12, 2009
We have a bit of a running joke in my neck of the woods which stems from a newspaper report many years ago detailing a high rate of diagnoses for ADHD in a local high school. The surprising part was the rather upscale demographic of the high school. Of course, once one became aware that having a diagnosis of ADHD or some other mental/behavioral disability permitted all sorts of extra attention and breaks to be extended to the school kid in question, the suspicious mind was satisfied.
Well of course. If darling kid is not performing above average, there must be SomethingWrongzOhNOes! Get some drugs, quick! (and, oh btw, let him get extra tutoring and untimed tests and some other stuff as well).
Today’s tip is from The Common Man who points to this AP article.
Baseball authorized nearly 8 percent of its players to use drugs for ADHD last season, which allowed them to take otherwise banned stimulants.
…
The National Institute of Mental Health estimates 3 percent to 5 percent of children have ADHD, according to its Web site [ED-link].
…
Just eight TUEs were granted for illnesses other than ADHD: three for hypertension, three for hypogonadism, one for post-concussion syndrome and one for metabolic myopathy. The 114 overall TUEs was up from 111 the previous year.</small
Lord knows MLB players would never use amphetamine class psychomotor stimulants to improve play. Nor could there be any reason to seek a legal exemption to use stimulants. That would be just cynical talk.
Maybe they should just switch to benzothiazepines.
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small caveat, ADHD rates are 2-3 times higher in boys than in girls (this cites NIH info for the summary). Given that pro ballplayers are all male we need to think of this 8% rate in that context.
DrugMonkey 
January 12, 2009 at 5:36 pm
Hmmm… needing a stimulant to maintain attention during a high level sport.
Does this mean that baseball is as boring as high school?
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January 12, 2009 at 5:49 pm
“Does this mean that baseball is as boring as high school?”
“pro ballplayers are all male “”
IOW, yes. Moreso, technically.
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January 12, 2009 at 5:55 pm
“Does this mean that baseball is as boring as high school?”
Moreso, technically.
“pro ballplayers are all male ““
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January 12, 2009 at 6:36 pm
There was speculation last year that batting numbers were up because of the amphetamine testing, with hitters more patient and less twitchy. Maybe they were just on something more effective instead.
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January 12, 2009 at 6:39 pm
What’s with the explosion in “Adult ADHD”? Is it possible that this diagnosis a consequence of aggressive drug company sales pitches to sell more amphetamine? Last week I took an online quiz to see if I might have adult ADHD. I scored a 59, which is “moderate ADHD.” I guess I need some Adderall, and I don’t even play baseball.
Another troubling trend is this recent Nature article arguing that more healthy people should use cognitive enhancing drugs. Though I’m willing to entertain the possibility that some cognitive enhancers might actually produce long-term benefit, the enhancer featured on the front page of the article is Adderall–good old speed. Have the decades of documented problems with aggressively prescribing amphetamine as medical therapy been forgotten already?
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January 12, 2009 at 7:01 pm
What’s with the explosion in “Adult ADHD”? Is it possible that this diagnosis a consequence of aggressive drug company sales pitches to sell more amphetamine?
A good question. Yes, drug companies want to sell more drugs and correspondingly push to diagnose more categories of less-symptomatic individuals that could benefit from their treatments. Some academic scientists conduct research that may be viewed as assisting this process. Is it craven? Well, if one is really convinced that there are people out there that could be helped and are not being helped because they are not being identified (see my recent comments on drug addict identification/parity/etc) then no, this is just well-intentioned activity to improve public health.
If we believe that there is a real disorder such as ADHD in children (and I do) then there are essentially two alternatives. Perhaps it is purely developmental stage-related and kids grow out of anything pathological. Alternately, kids do not grow out of it and the disorder (whatever the underlying etiology) persists into adulthood.
Growing out of it is a fair enough bet at the outset. If you think of the sort of pathology (behavioral and to an extent neurobiological) that has been reported it points us at the frontal cortex. An area which we might think of as the last-maturing part of the brain which undergoes significant developmental change right into late adolescence/early adulthood.
If ADHD persists into adulthood, it may be the case that it has previously been overlooked (even more so than childhood ADHD) because adults are more able to develop coping strategies. There the field is wide-open. Do individuals go into vocations that are more permissive of the behavioral disorder? Do individuals develop pharmacological self-medication strategies (tobacco smoking being a suspect)? Is the disorder mild enough after development that individuals just sort of get along in the lower part of the distribution of normal vocations?
And we’ve touched on the whole Nature obsession with cognitive-enhancers for brain-workers a time or two. I really don’t know what their deal is on this and some of the people involved really should know better. It is very hard to come up with good, side-effect free evidence of sustained brain-performance enhancers in normal, non-aged humans. OTOH, it is cynical to refuse to believe that there may be some perfect new approach over the horizon just because of this past (*failed) history.
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*in the sense that drugs which have legitimate pro-cognitive effects have big ol’ whopping drawbacks which prevent general adoption.
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January 12, 2009 at 7:41 pm
@ JSinger
FYI, scoring went down in the MLB in 2008 by a little more than 2%. I’m sure that some of the players weened themselves off of “greenies” and onto other stimulants not banned by the rules, but were less effective. Coffee and caffeine pills were undoubtedly in short supply.
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January 12, 2009 at 8:15 pm
Interesting that you post this on a day that two presumably clean greats, Ricky Henderson and Jim Rice (finally — what a player) get voted into the baseball hall of fame while the obviously tainted Mark McGuire got even fewer votes than in previous years. Can’t wait to see what happens when Bonds and Sosa come up for election.
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January 12, 2009 at 9:20 pm
I believe that a lot of the time kids are put on ADHD meds as the “easy button” solution for behavior problems or cover up a teachers incompetence.
My 2nd grade teacher tried to diagnose me with ADHD based on the most ridiculous things. I would break the line walking down the hallways to tie my shoe… refuse to read (boring baby books!) etc. My mom had a rough exchange of words with her (elementary school teachers are no match for my RN mom…).
All I remember is being extremely bored with class… I remember a day when the teacher took away a chapter book from me because she believed it was too difficult for me.
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January 12, 2009 at 10:51 pm
Beaker | January 12, 2009 6:39 PM (#5):
hm, got an 89 on that quiz. Had to laugh at what it says:
I would like to know … what, if any correlation is there between scores on tests like this, and later diagnosis from trained mental health professionals?
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January 12, 2009 at 11:05 pm
I took the ADHD test, and it gave me a lovely profile badge which reads: “I’m ADHD free!”
Though some of the questions were “huh?” – “My moods have highs and lows”. Whose don’t?
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January 12, 2009 at 11:28 pm
My moods have highs and lows”. Whose don’t?
Equally vague “symptoms” comprise most of the official DSM-IV criteria. This link is a guide for family physicians, to help them diagnose adult ADHD. Most of the criteria, all of which are self-reported by the patient, include “hot temper,” “inability to complete tasks,” and “impulsivity.” This is not medical science, it’s 1940s-era psychobabble.
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January 13, 2009 at 1:43 am
Throwing around terms like psychobabble suggests you are at the least uninformed on the way clinical diagnosis is made, particularly in formal research settings. The field is no more responsible for fringe elements and woo than is any other medical specialty. Now if you would care to talk about how psychological constructs are operationalized and inter-rater reliability, replication of findings and the like, I’m listening.
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January 13, 2009 at 7:11 am
Throwing around terms like psychobabble suggests you are at the least uninformed on the way clinical diagnosis is made, particularly in formal research settings
That would be correct. I’m way outside of my field here. But is seems obvious that “operationalizing psychological constructs” (sounds like a military term, but I think I get it) is more difficult to quantify and standardize than, say, blood pressure or cholesterol levels. There may not be any more fringe science operating in clinical psychology, but the nature of diagnosis makes it far more open to manipulation and abuse–by both patient an clinician.
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January 13, 2009 at 3:09 pm
I scored 95 on that ADHD test. But then I was diagnosed with ADHD when I was 26 (8 years ago now) and have been on Adderall since. When I take those type of tests, I have to decide, am I answering as if I’m medicated or unmedicated. Because the meds have a very profound effect that allow me to keep a job, not go off at every little thing, enjoy spending time with children, etc.
I agree with what DM said about adult ADHD. I think that those of us with the condition that have made it this far have developed many coping strategies that, in some cases, allow us to operate without notice. The success of those strategies depends greatly on the severity of the condition and the environment the individual is in. I was able to succeed in the world of computer programming just by coping, but my condition limited my potential to advance in the workplace and was making interpersonal relationships difficult.
As for children, I feel that the typical education system doesn’t provide very well for the very different ways that ADHD people learn. Since there is so much focus on conformity and group activity, it can be very difficult for an ADHD child to get through the system. Unfortunately, rather than realizing that people learn in different ways and that ADHD kids can thrive if the environment is right, many school teachers and administrators opt to go the easy route of “give the kid a pill”.
I’m no scientist, but I personally tend to view ADHD as a difference in brain structure/thought patterns/biochemistry or whatever rather than as something damaged that needs to be repaired. I opted the route of medication because in the existing social structures of society there are things that just need to get done and my condition was not allowing me to do those things.
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January 13, 2009 at 3:21 pm
But is seems obvious that “operationalizing psychological constructs” (sounds like a military term, but I think I get it) is more difficult to quantify and standardize than, say, blood pressure or cholesterol levels.
Yes, Maybe. Although you would be surprised how much variance there can be from lab to lab and assay to assay with supposedly easily quantifiable stuff using machines that go ‘ping!’
http://scientopia.org/blogs/drugmonkey/2008/07/sports-doping-analytical-chemistry-is-not-magic
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January 13, 2009 at 4:02 pm
Beaker
You can fuck with blood pressure and even cholesterol if you feel so inclined. Blood pressure especially.
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January 13, 2009 at 4:11 pm
CyberLizard, I appreciate hearing the perspective of a person who is clearly benefitting from ADHD therapy. I presume that in your case the benefits of chronic Adderall use outweigh the negatives. From your perspective, what are the negatives (if any)? Do you have crash periods accompanied by amotivation, ahedonia, or lethargy when the drug wears off? Cardiac symptoms? Does the “differentness” of your ADHD brain get squelched by the Adderall, thus changing or suppressing part of what you consider your “normal” personality? Since I lecture about stimulant therapies, I’m just trying to get a better handle on the cost/benefit analysis for people like yourself.
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January 13, 2009 at 10:55 pm
I used to be certain that ADHD was simply bad/lazy behavior and drugs were for the benefit of teachers/society rather than the patient. I was 110% against the idea of drugging children, and fought hard against it in situations where I had some influence. But over the last few years, I’ve carefully followed the data concerning development and behavior, and had second thoughts. Finally, I agreed to have my own son pharmacologically treated for ADD. The difference is staggering. It turns out the trait is common in my family (supported by genetic studies) and every family member reports amazingly similar experiences with regard to coping and effects of drugs. Certainly amphetamines improve cognitive ability scores in ‘normal’ people also, but I think there is something fundamentally different going on in ADD/ADHD people that goes way beyond a simple ‘focus booster’. Of course, we can argue all day about whether ADD/ADHD is really a ‘disease’ in need of treatment (and there are good arguments for ADHD being evolutionary beneficial in certain conditions), but there is no doubt anymore in my mind that ADD drugs are more than simply behavioral control or focus aids. I am curious to see long term studies of brain development on drugs versus untreated, to see whether drugs in pre-pubescent children simply accelerate normal changes (many untreated children seem to outgrow ADHD around puberty) or whether plateau performance is actually different in the end.
Some of the most compelling work, to my mind, suggests that ADHD is linked to alterations in dopaminergic signaling. It may be that ADD/ADHD drugs work not because they are ‘focus aids’, but rather because with chronic use they downregulate dopamine transport. As if ADD/ADHD were some sort of weird ‘anti-parkinsonism’.
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January 14, 2009 at 6:18 am
HAHAHAHAHAHAHAHAHAH!!!!!!!!! (I’m not laughing at your son; I’m laughing at you, asshole.)
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January 14, 2009 at 7:25 am
ADHD medications are stimulants. They don’t solve any non-ADHD behavior problems because the non-ADHD child gets stimulated and any behavior problems are made worse.
It’s an urban legend that ADHD kids are “drugged into submission” or “zombied”.
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January 14, 2009 at 7:55 am
There was a recent paper that demonstrated that an ADHD associated mutation conferred a ‘high’ activity level to the dopamine transporter, and amphetamine would reduce it to a ‘normal’ level. The authors suggested that this is why amphetamine actually reduces symptoms.
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January 14, 2009 at 8:27 am
“HAHAHAHAHAHAHAHAHAH!!!!!!!!! (I’m not laughing at your son; I’m laughing at you, asshole.)”
Why are you laughing at my asshole? Can you not look me in the eye? Or do you have some sort of perverted fascination with my asshole?
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January 14, 2009 at 8:33 am
How are you even seeing me asshole anyway, PhysioProf?
Waaaaaaiiiiittt a minute. I think you must be lying.
You jokester, you. All this time I thought you were serious. Ha! That *IS* funny.
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January 14, 2009 at 9:29 am
Tsu Dho Nimh:
That’s not entirely true. ADHD patients do often report feeling “drugged” when they are on their medication. That’s not to say that they are drugged into submission, but they do often report they don’t feel like themselves on the medication.
Also, the interesting thing about ADHD medication is that it does work for almost everyone. Even in children, and especially in adults without ADHD, the stimulants will increase focus, though they may not “slow” non-ADHD patients down. But focus is always increased, and behavioral problems will (with the exception of side effects) almost always get better.
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January 14, 2009 at 10:46 am
“Also, the interesting thing about ADHD medication is that it does work for almost everyone. ”
Actually, the REALLY interesting thing about ADHD is that the operational diagnosis for ADHD tends to be anything that improves after taking ADHD medication. So the fact that ADHD medications tend to work is sort of circular.
As for ADHD patients reporting that they don’t feel quite the same on medication… I should hope so! Isn’t that the point of all psychotropics?
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January 14, 2009 at 11:29 am
KristinMH –
I think you’re falling into the same trap a lot of people do and discovering why a clinician is an important aspect of diagnosis. That is not to say that some clinicians don’t fall into the same trap.
It’s not that most everything on the diagnostic criteria doesn’t affect most everyone, they do. The issue is the frequency and severity.
I would assume that you occasionally forget your keys or forget what you were going to the store for, right? Almost everyone does on occasion. You probably also have the occasional procrastination issues. And you also clarified that you have emotional highs and lows.
But let me describe a little of my life, when I am not medicated (which is usually the case, though that is changing).
On a daily basis, I have anywhere from five to twenty episodes of forgetfulness. If I make the five minute journey to the corner store, it is inevitable that I will have to go at least twice to get what I initially went for, sometimes three times. I am perfectly capable of making a grocery list and still wandering the grocery store wondering what I was going to get, because I either forgot to take the list or forgot it’s sitting in my fucking pocket. Or maybe I only put three or four of the thirty odd items I actually need on the list, before I rushed off to the store (yes, the procrastination can be that simple).
While I am very adept at not letting them ride all over my face, my emotions are a major fucking roller coaster. Jumping up and down in a matter of seconds. On the upside, if I don’t like how I feel that particular moment, I can wait a second and it’ll change for the better. On the downside, I am perfectly capable of weeping because of the story of a complete stranger losing his pet mouse, i.e. I have emotional reactions to stories that outweigh the reaction of the affected parties. (I should note that this is more likely a trait of my bipolar, than a ADHD trait)
So it’s not that the traits listed in that quiz are unique to people with neurological issues, the frequency and intensity of said traits are an integral aspect of diagnosis.
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January 14, 2009 at 11:37 am
scicurious –
Also, the interesting thing about ADHD medication is that it does work for almost everyone. Even in children, and especially in adults without ADHD, the stimulants will increase focus, though they may not “slow” non-ADHD patients down. But focus is always increased, and behavioral problems will (with the exception of side effects) almost always get better.
This is simply not true. Kids and even some adults who use ADHD medication, who don’t need it, tend to have a oppositional reaction to the meds. A person without ADHD taking ADHD meds will tend to get rather more hyperactive, instead of less. They may see some improvement of focus, but usually only when it is used to compensate for fatigue.
In effect, people without ADHD who take ADHD meds, will usually exhibit some or even most of the symptoms of ADHD.
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January 14, 2009 at 7:31 pm
For the win, CPP! For. The. WIN.
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January 15, 2009 at 4:15 pm
All four of us in my family have attentional disorders.
My husband was medicated in school so that he could manage to focus long enough to do things like learning to read. He now works in trucking, where the stimulus is always changing, and his rapid shifts of attention and being drawn to the stimulus are useful attributes that keep his accident rate down and his arrival times good.
Myself, I knew I had trouble paying attention if it was at all boring, and cannot to this day take notes AND listen at the same time. In college, I listened to the lectures while taping them, then came home and took the notes off the tape. The procrastination was harder there, though, because things became less and less the sort of thing you can toss off in a four hour bout of hyperfocused concentration. Essentially I have two states; diffuse (Oooh, shiny!) or so concentrated that a shout won’t break through, I have to be physically touched. I don’t have a middle point, unless I’m medicated. I don’t multitask at all well. This was a problem when the boys were small.
The eldest (13)hyperfocuses like I do, but is not hyperactive. To give him the ability to move his attention around normally, without shifting away and losing important bits of information, he takes a very low dose of Ritalin before school. We work constantly to give him good habits and behavioral support so that he can, perhaps, manage without the meds someday.
The youngest (8)is hyperactive. He didn’t care if you spanked him, but time outs, even for two minutes, were agonizing. Even at six years old. Unlike his brother, he has been to the ER numerous times for taking an impulsively hands-on approach to life. (Why did you jump off the porch roof?” “To see what would happen.”) Ritalin gives him the ability to pay attention long enough to develop a love of reading and learning, and to make the grades he wants to make in school. We are also supporting him with teaching him management strategies, but the meds make the difference.
I will also add that the pregnancy during which I had the flu, and came out on the other end with fibromyalgia, made the attentional issues worse. I am going to have to seek some help for this, because now I don’t have the energy to keep my brain in line.
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January 15, 2009 at 5:27 pm
Alexandra –
The youngest (8)is hyperactive. He didn’t care if you spanked him, but time outs, even for two minutes, were agonizing. Even at six years old. Unlike his brother, he has been to the ER numerous times for taking an impulsively hands-on approach to life. (Why did you jump off the porch roof?” “To see what would happen.”)
That was so me as a kid. One of my favorites was when I was eight. I’m at church with my mom and all of a sudden she notices that I’ve disappeared. She quickly realizes that I’m nowhere to be found and finds a deacon to get some help. So he gets some of the others looking for me. About five minutes later he finds my mom and asks if I happen to have blond hair and am I wearing whatever I happened to be wearing that day. She says yes and he says, “turn around.”
I was on the platform, in front of the fifteen hundred plus congregation, stalking towards the pastor from behind. Mortified is putting her state at that point mildly. The pastor OTOH, just used me as an object lesson and found it terribly amusing. So I get the whooping of my life, to which I respond with a grin, “but pastor Ollie thanked me for my help, so it must have been OK.”
My second favorite was blowing a 5′ diameter crater in the back yard, using homemade nitroglycerin in a (thankfully) cardboard mortar. That was the point that it occurred to my folks that they should take a more hands on approach to my chemistry fun. Oddly enough, this was after I singed everything in the laundry room, when I decided to produce hydrogen gas and managed to produce something else that was less volatile, but highly flammable nonetheless.
You sound like you’re doing a very fine job of working at it. As a father with severe ADHD, of a seven year old (too early to tell with the one year old) with severe ADHD, I am damned well aware of how challenging it is. On the flip side, it’s also pretty fucking awesome sometimes. The things he notices and comments he makes sometimes, are just mind boggling.
And hey, I know to pay closer attention to what he’s reading and the sorts of chemicals he might ask for as he gets older. Not that I have issues with him trying to make his own fireworks (ever my goal as a kid), but I am rather keen on making sure he doesn’t burn down the house or foster visits from the FBI.
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January 16, 2009 at 3:35 am
I feel like #15 mirrors my experience fairly closely. Before I was diagnoed with ADD and started taking medication – halfway through college – I was having intense focus problems. Couldn’t read more than 2 or 3 pages of a book at times. From elementary school onwards, teachers would comment that I wasn’t reaching my full potential.
I’ve found that Ritalin and, more recently, Concerta have helped immensely. People don’t think that my personality has changed, and I’ve still got procrastination and organizational issues, but I can operate like a normal person when I want to. I don’t think that the drugs have impeded my creativity at all.
The only real problems have been some logistical issues with getting medication while travelling or moving to different states, and some early problems related to exercise. When I started on methylphenidate, I was biking about 6 steep, hilly miles a day. I felt that the medication made physical exertion more uncomfortable, and recovery took longer.
Final comment…I sometimes hear people ask questions like, “What happened to these people before? Why didn’t we have problems like ADD before drug companies discovered they could make money on them?”
I find that to be an interesting question. In the past, was our society comprised of near-100% successful people? Didn’t we have people who went from job to job failing to do well? What about hobos? Homeless peole in general? They’re a new phenomenon?
My point in this is, it’s clearly the case that many people in our society have problems. To suggest that a psychiatric condition can’t be a serious problem because somehow we would have noticed it is ridiculous.
OK, bonus comment: In my persona, subjective experience, Concerta is a much better drug than methylphenidate. I know it’s the same drug, but the fancy Alza capsule seems to really get the dosage spaced out nicely.
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January 3, 2012 at 7:33 am
[…] by the system, just reinforces cynical suspicion about other athletes. Suspicions based on mostly circumstantial evidence in the absence of a […]
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