What if it’s not ADD? | ADHD Information
[QUOTE=John D]So MaxDad, when you say "Anyone who has been diagnosed according to the APA DSM guidelines knows that there's no way to be accurately diagnosed in a few minutes" I'm curious if you are referring to the types of tests conducted or to the guidelines themselves (the 8 for inattentive and the 8 for hyper (something like that)). I don't disagree with you that a real diagnosis takes more than 15 minutes, what I'm curious about is if there's a standard set of tests that are relied on for making a diagnosis. My sense is that there isn't, which leads to continued discussion about ADHD over and under diagnosis (depending on whatever expert is giving the opinion).
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John
You’re highlighting yet another problem. The guidelines do not clearly define a testing routine. They define what symptoms to look for … but not specifics on which tests provide the most accurate assessment.
However, that is not (in my opinion) the most significant problem with diagnosing ADD. Whether there’s agreement among clinicians about tests and testing regimens’, that doesn’t make GP’s and Pediatricians any more knowledgeable about interpreting results and understanding the nuances of neuro-biological disorders.
About five years ago I had this overall depressed feeling that would just not go away. So I went to my GP and mentioned it to him. He then went to his office and then returned with a 13 item depression assessment questionnaire for me to fill out. I filled it out, he scored it, and said with total confidence that I had “moderate” depression and then prescribed Wellbutrin. Of course the Wellbutrin did very little for me, which is understandable because a successful diagnosis back then would have indicated ADD and Bi-Polar. Yet, there was no question in his mind about the result.
What I find so perplexing is that most MD’s think nothing of referring a patient to a specialist for a huge variety of conditions, however, when it comes to ADD, they feel totally qualified to recognize the disorder in a few minutes.
[QUOTE=integrtydispair]John, it is more complex, naturally: the dx could be made quickly and accurately given differing circumstances. how well the doc knew the pt history. [/QUOTE]
Integrty
I respectfully disagree. Like I said above, there are to many nuances for GP’s to realistically understand. For example, Bi-Polar and ADD share a variety of similar symptoms and a doctor needs to be very familiar with how to sort it all out.
Even family history can be deceiving. A doctor could easily surmise that a child patient is ADD because a parent is also. However the child could be autistic, dyslexic, depressed, have Asperger’s, etc.
MaxDad
Maxdad39126.3971643519 I went through a series of Instruments and Procedures before being diagnosed. That looked not only for ADHD, but anything else that could be similar to it.
Here is what they were (not that I really know what these are, other then I did the tests, but professionals would). I hope this also shows some of you out there that there are other ways of diagnosing other then just a few minutes in a Dr's office.
Wechsler Adult Intelligence Scale- 3rd Edition (WAIS-III)
CPT-II
Brown ADD Scales- Adult Self Report
Brown ADD Scales- Adult Observer Report
CAARS- Self Report: Long Version (CAARS-S:L)
CAARS- Observer: Long Version (CAARS- O:L)
Minnesota Multiphasic Personality Inventory- II (MMPI-II)
Revised NEO Personality Inventory
Clinical Interview
Review of Records
I was finally diagnosed with ADD Inattentive Type and High Functioning Borderline Personality Disorder w/o self harming, being abusive, or having suicidal tendencies
Before I went this route, I had already had my Thyroid tested, Kidneys and many other tests done because I was not able to lose weight. The Thyroid tests came back normal as did all the other tests but one. I'm 'borderline' diabetic... official diagnoses is "Insulin Resistant" My sugars aren't high enough to be diabetic, but if I don't take Glucophage to help maintain my sodium and sugar levels I will become a diabetic within 5 years.
So, I'm certain with my diagnosis of ADD that it is accurate and the same goes for my daughter.. she did a similar bout of testing as I did,but for children.
Now, if I had walked into a general practitioners office and told him/her my symptoms and only after a few moments be given ADD meds then I would be concerned and seek a 2nd, or 3rd opinion by someone that specializes in ADD and other disorders that are parallel to it.
I am however getting a 2nd and 3rd opinion before going on meds. On the 21st of this month I'm seeing another Psychologist that will be doing my therapy sessions and I'll speak with her to see if she agrees with the Psych Eval. Also the same day I'm scheduled to see a different Psychiatrist to see if he agrees with the results and both of the other Drs. Then, and only then will I decide if Meds are the right way to go for me.
My daughter I did the same thing... had the testing done in one place, went to 2 other Drs (Psychologist and a Psychiatrist) and she was diagnosed with ADD Inattentive Type and they removed the Early Onset of Dysthymic Disorder that the Eval had stated she may have. (This was due to her being picked on at school at the time, and has since been rectified)
ShawnB39126.365Shawn
Kudos to you and your provider. You've definitely had a thorough examination. In addition to similar tests as yours, I also took the Conners Continous Performance Test. It was the CCP that really convinced me I was ADD.
MaxDad
So MaxDad, when you say "Anyone who has been diagnosed according to the APA DSM guidelines knows that there's no way to be accurately diagnosed in a few minutes" I'm curious if you are referring to the types of tests conducted or to the guidelines themselves (the 8 for inattentive and the 8 for hyper (something like that)). I don't disagree with you that a real diagnosis takes more than 15 minutes, what I'm curious about is if there's a standard set of tests that are relied on for making a diagnosis. My sense is that there isn't, which leads to continued discussion about ADHD over and under diagnosis (depending on whatever expert is giving the opinion).
Aloha John d.
like your thought ful posts. happy for you on te sex!!! may i live so long. smile
John, it is more complex, naturally: the dx could be made quickly and accurately given differing circumstances. how well the doc knew the pt history. there is s "qeeg" that is used for dx according to the ever popular doc hallowell and ratey who wrote delivered fro distraction.
best wishes
You did a fine job. I was not considering the way we take stimulants versus the garden variety crack head would. I could see doing a line of Adderall being quite the motivator. Till your head exploded, or you moved on to freebasing Mountain Dew.
All kidding aside good job clearing that up for me.
Thanks ParduseI will admit to a total lack of understanding when it comes to snorting, injecting, etc. Of all of the dysfunctional behaviors I already have I'm sincerely glad I never had that desire. Although my wife would probably wish that I was glad I never had the flatulance desire ... oh well, such is life.
Fortunately or unfortunately I've become more knowledable on the topic you brought up. While I've been treated for ADD for over a year, a few months ago a bi-polar diagnosis was added so I'm in the middle of dealing with trying to figure out the optimal med mix.
Peace to you
MaxDad
I would not be surprised if more than 50% of those diagnosed with ADD are mis-diagnosed. Pediatricians and GP's are nortorious for diagnosing and prescribing meds for patients with ADD in a 10-15 minute appointment. Anyone who has been diagnosed according to the APA DSM guidelines knows that there's no way to be accurately diagnosed in a few minutes.
Also, when you follow the ADHD Medications board you see post after post of med questions that would have been explained up-front by a Dr who knew how to diagnose and treat ADD. However we still see basic question after basic question.
So I am certain that many could easily have other conditions but get a ADD diagnosis. One example is bi-polar depression which shares a number of symptoms as ADD.
MaxDad
I wonder too.
I had a horrific childhood with lots of hitting,screaming in school and at home.
Sometimes I wonder if I just "tuned out" and my brain just got wired this way.
My symptoms became better when I was with my grandparents or in a foster home.
I have hypothyroidism and I still think I have ADD because I haven't had hypothyroidism my whole life. That's the difference.
It's funny you bring it up because my thyroid was suspected when I brought up my concerns and curiosity about ADD and it turns out I do have an underactive thryroid but as I said, I don't think it's just that. I'm on meds for my thryoid and they did give me a bit more energy but the mental fog ADD stuff is still there.
I don't know of any other simular condition that is treated with stimulants. If your on a stimulant and not an addict then I would say its ADHD.No, I really do think hypothyroidism CAN mimic certain ADD symptoms.
I'm simply saying it's worth looking into but if you've had ADD symptoms your whole life.........I mean, have you had hypothyroidism your whole life? That's for a doctor to figure out. I believe I have both but I find it very hard to believe that nobody would have checked my thyroid all these years. My thyroid medication has helped a bit with my fatigue but it isn't affecting the fact that my brain still races all over the place or I can't ever get motivated when I should or be able to get organized, etc.
Does anyone ever wonder if it's not ADD and that they might have a condition that mimics it?I just came across and article about hypothyroidism and the symptoms are very similar--mental sluggishness, excessive sleepiness, etc.
So I'm wondering if some people are misdiagnosed. Parduse
That's a good question (and you're definitely not coming across as a smartass).
I interpret your question two ways. First, is taking a med that is not correct for you “drug abuse”? And second, is taking a med that is not correct for you result in becoming addicted?
First question: Drug abuse is not a symptom but instead is an intentional behavior. If someone obtains Adderall from a friend and is not under a doctors care for ADD, then that is drug abuse. If someone who is diagnosed and has a script for Adderall consistently deviates from their dosage, then that can be drug abuse.
But the responsibility for determining the treatment is with the doctor and it is their responsibility to follow best practices in diagnosing an injury, disease, condition or disorder. If someone has been truthful with their doctor and they follows a doctors treatment plan then "drug abuse" by the patient cannot be possible.
Second question: True addiction to stimulant medicines only happens with folks who intentionally use the med to get high. But to do that they have to do things like chop up a bunch of pills and snort the powder or take really excessive amounts.
If you subject your body to a drug that quickly gets absorbed then in time your body will crave that rush and you become addicted. That’s why drug addicts usually snort or inject drugs. They get absorbed into the bloodstream almost instantly and the brain gets hit like a tsunami. Then of course the brain wants to experience that again and again.
In fact, tobacco companies have always known this and have intentionally added chemicals to cigarettes for the effect of causing a chemical reaction version of “free-basing”. The brain gets this very fast rush and desires more and more.
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Now if someone is ADD but is taking BP meds, or vice versa, then there may, or may not be negative consequences. Some anti-depressant meds can be helpful to those with ADD. That’s why Wellbutin (an anti-depressant) is sometimes prescribed for ADD. However sometimes someone who is BP can make their condition worse by taking a stimulant med.
Because there are so many symptoms shared between ADD and general depression and BP depression, some meds can cross over and be helpful. If they are not helpful then the potential risk is not drug abuse or addiction, but things like increased risk of suicide, deviant behavior, etc.
If you are especially interested in both ADD and Bi-Polar depression, then an excellent resource site is http://www.psycheducation.org/ by Dr. Jim Phelps.
I hope this answers your question. If not then rephrase the question and I’ll do my best to write another way-to-long response!
MaxDad
Maxdad,
Correct me if I am wrong, but those of us on stimulants would show signs of drug abuse if it were bi-polar or just depression wouldn't we? Since adderall is an anphedamine. I'm not trying to be a smartass if it sounds that way.