the clash over ADHD diagnosis | ADHD Information

Side tracked: the clash over ADHD diagnosis

Psychology Today, Sept-Oct 2004, Willow Lawson

You're distracted at work, behind the wheel, at dinner with your spouse. You can't remember what someone said just minutes after speaking to them. When you see one of those drug ads on TV, you think, "Hey, that's me! I lose my keys all the time."

It seems like half of the working world is wondering whether they have attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). Word is out that it doesn't affect just kids: Experts say attention deficit also strikes an estimated 4 to 8 percent of adults, many of whom bad it as children but were never diagnosed.

Now overstimulated, overscheduled grown-ups are flocking to doctors in hopes that a pill can cure a scattered brain. But unlike the fairly clear-cut symptoms of depression and schizophrenia, symptoms of ADHD are considerably fuzzier. A diagnosis is in large part a doctor's subjective interpretation. (Characteristic patterns have been detected in brain scans of ADHD patients, but few doctors use them in diagnosis.)

ADHD may manifest in a variety of ways: restlessness and distraction, short-term memory impairment, blurting out inappropriate thoughts, difficulty organizing activities, failing to follow through on a project or finish one's work. In short, all behaviors that are part of being human in the modern world. Perhaps that's why a recent Kaiser Family Foundation poll found 20 percent of Americans believe ADHD is a bogus disease.

So when does normal behavior cross the line? For clinicians, the buzzword is impairment: The symptoms are so severe that a person is failing in some part of life. Among experts, however, there is strong disagreement over what the standard of comparison for impairment should be. Should a distracted lawyer be compared with others who have similar cognitive abilities? I should a lawyer be compared to a grocery store clerk or a bus driver--whose job doesn't require the same intellectual focus?

Some researchers say there is a danger of creating different standards for various strata of society.

Already, there's evidence that a diagnosis of attention deficit depends largely on socioeconomic status and access to mental health care. Of adults who are diagnosed with ADHD, 73 percent are white, while only 15 percent are Hispanic and 6 percent are black. "ADHD is now a boutique diagnosis for middle-class people," says Ronald Kessler, a professor of health care policy at Harvard Medical School. Among professionals, "the attitude is, 'if I have a concentration problem and it affects my job, and this is an illness I can fix, then I want to fix it,'" he says.

Russell Barkley, a professor of psychiatry at the Medical University of South Carolina in Charleston, advocates more restraint in diagnosing and medicating ADHD. He argues that too many people believe intelligence should equal success, when it is merely a benchmark of one's cognitive ability. "It's not an indicator of how well your job or your family relationships should be going," he says.

The point of comparison, Barkley says, should be what is normal for an average, healthy adult. People who truly have ADHD often have segments of their life, such as work, finances or parenting responsibilities, that are a complete disaster. "Unless you can show me that you're functioning below normal--not simply below your level of intellect--you don't have a disorder," he says.

Thomas Brown, associate director of the Yale Clinic for Attention and Related Disorders in Connecticut and professor of psychiatry, says it would be wrong to withhold medication from a person who is high functioning, but still struggling. One of Brown's patients is a young man who scored a 1.37 grade point average in his first semester at Duke University, despite scoring near 1400 on the SATs. "He wasn't partying," says Brown. "He just couldn't get organized. He couldn't remember what he'd read." Brown diagnosed ADHD around Christmas time, prescribed a stimulant and in the spring semester the student's GPA shot up to 3.74.

One could make the argument that if a student can't keep up at a top college, he shouldn't be there in the first place, says Brown. "But why not treat them?" he asks. "Are we only going to provide glasses to people who are practically blind?"

In the meantime, more Americans are visiting their doctors for a screening, which is a good thing, says Kessler. His studies show that only a small fraction of ADHD sufferers are being treated. Moreover; an increase in ADHD screenings is almost certain to turn up other serious disorders: About a third of people with ADHD abuse drugs, and another third will suffer depression. Anxiety disorders are common with ADHD, while over half of people with ADHD of all ages have a major learning disability. Says Kessler: "I've had people come in thinking that they have ADHD, but actually they had a whopping huge depression."

Hey Brook! I actually read the first & last paragraph!
ADHD/LD/Panic disorder - I'm normal!
you're cured

On and off drug abuse, alcohol abuse, depression, miserable short term memory even before drugs/alcohol,finances shot to H3II, can't even seem to cook lately without the smoke flavouring. Yeah , its just stress, you'll get over it!!

Been "stressed" for over 30 years.

hey repairman, at least you were nominated for awards on ogram's site...

not one nomination for moi.. not one

i still haven't been diagnosed by a dr.

'oh, you're' depressed, let's treat that.' 'you're probably bipolar, let's look at that'

yeah, i'm depressed. 30-some years of trying hard to just to function at the same level as my peers and failing. i'm a rocket designed to reach the next galaxy, and here i still sit on the launch-pad, shaking and sputtering. this constellation of symptoms has impaired every aspect of my life.

bi-polar? can't find a single episode that sounds manic. the closest is the insomnia i suffer a few times a year.

can't maintain any relationships. easily frustrated. can't seem to finish anything. jack-of-all-trades, master of none syndrome. can't have conversations w/o taking off in a milllion directions. that's the way i think too. etc., etc., etc.

i take the self-test quizzes, and score just about as high as a person can for adhd. not a test i'm happy to get an A+.

all this and more, and the dr.wants me on zoloft! 3 different anti-depressants, and the only measurable result is one made me go beyond just thinking about suicide.

it's too bad med schools let in so many dolts. i think most of them are there for the status, and have no aptitude or talent, or love of the medical arts.

i'm with repairman- after more than three decades of looking for solutions, i think i qualify.

You should've been nominated "most researchful" in the class,as a teacher, i guess this is an A+

We listened to the Dr. that made the diagnoses at first but this is not the main issue in our son it's Asd. All these kids also have attention issues as PSM as stated before. Do to the Spd they can't focus cause it makes things distorted for them. I reccomend another opinion. This is true if your child has some spd issues. We knew that dr. had to be wrong. This place speciallizes in the Autism area.We thank god we know now.

no !!!

but at least you were nominated.. be greatful...
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