I love your comment about why ADHD wasn’t diagnosed in kids many years back.

It is a fairly overwhelming experience to find late in life, after some wheels come off for no apparent reason, that, yes, it sounds like you have classic ADD symptoms. Running the video of your life back in time is edifying when it passes moments and instances that — with this new knowledge — you recall for their confusion, bad consequences, or general inexplicability. When I was in my 20′s I visited a high school teacher of mine who allowed as how I had a good mind, but a “lazy mind.” I had no idea what he meant, and immediately put it out of my mind. 30 years later that moment takes on a different meaning.

Like any other molecule in the body, those in the brain that manage connections that create what we describe as focus, retention, and other qualities are just as susceptible to genetic and environmentally defined attributes as any other.

As a teen, I discovered that tobacco virtually solved my focus/motivation problems, and I used it to get through college. Soon after graduating, I was trying to quit with the help of a doctor and began using Ritalin and subsequently Adderall, both of which had incredible initial effects, albeit dwindling returns with tolerance. They are still somewhat effective today, as evidenced by return of symptoms with drug holidays.

It seems to me that the most reliable indicator in support of an ADHD diagnosis is when there is a clear positive effect from taking stimulant medications (or nicotine/caffiene for that matter). There are many kids for which they don’t work, or even have a negative effect on attention and/or mood. In these cases, the root cause seems likely to be elsewhere, possibly an ASD or bipolar/affective condition.

So whether or not ADHD is considered a real “disorder” is largely irrelevant. The differences in brain structure and/or chemistry that are being consistently demonstrated by science in people with the ADHD symptoms are real, and have evolved for a purpose, likely that of the “hunter” archetype, a disposition that is relatively less common in and definately ill-suited for our culture.

Specific diagnoses for most personality, developmental, and affective conditions are largely meaningless, a posit that is supported by the frequent comorbidity with other diagnoses and the wide discrepanpcy in response to drug therapy exhibited across the patient population.

The truth is that people having difficulties exhibit a range of symptoms which are a subset of the combined list of symptoms for many if not most of these diagnoses. If drug therapy is to be used, it should be focused on finding the medication that relieves the symptoms most effectively rather than what drugs are used/approved for a given diagnosis and what dx number is reported to the insurance company.

Jeff

Until recently, psychiatry was largely influenced by practicioners of the non-biological bent. Dysfunctional human behaviors were attributed to everything but biology (and much was blamed on the mother). Today, scientists such as the highly respected Dr. Nora Volkow are helping us to understand that the brain is not only an organ, it is the most vulnerable organ — vulnerable to both genetic and environmental factors that take place before we are even conceived.

Any student of history can see that brain dysfunction has been with us always. It’s only now that we are understanding its genesis and, hopefully, healing strategies.

As for kids not having ADHD twenty odd years ago, most certainly they did. I meet and hear from them every day. They are now well into adulthood and often carry significantly burdensome emotional baggage from going undiagnosed for their entire lives. They sincerely wish that someone had mentioned ADHD as a possibility two decades ago. And these are the lucky ones — the ones who didn’t die in car accidents, succumb to substance abuse, drop out of school, or become incarcerated.

I also meet newly diagnosed adults with ADHD who are in their 50s, 60s, 70s, and even 80s. ADHD has been with us always, it seems. Here is a blog post about a medical textbook from the 1700s that documents the presence of what sounds like ADHD: http://adhdrollercoaster.org/adhd-in-the-news/newsflash-adhd-dates-back-to-1798-at-least/

As our society becomes more complex and requires more of the so-called Executive Functions (planning, prioritizing, etc.), ADHD often becomes more obvious.

Do any of these kids get a chance to run around and play with their mates and climb trees and do all the things that most kids did years ago. Most of us ate plenty of sweets and drank fizzy drinks etc back then but at least we were able to burn off our energy.

I just can’t get my head round the idea that kids DIDN’T have ADHD prior to twenty odd years ago and get put on speed as a consequence, and now millions of kids (but mainly only in the US for some strange reason!) supposedly have this mental disorder and are prescribed powerful drugs that make the pharmacuetical companies billions of dollars evey year thank-you-very-much.

I have no faith whatsoever in a bunch of people who regarded homosexuality as a mental disorder but then withdrew it from their DSM in the 1970s after big protests by the gay community and the political pressure brought to bear on them as a consequence. That’s not medical science, it’s complete farce.

From what I know of Dr. Volkow (attending several of her lectures, etc.), I think she takes a pretty nuanced view. In other words, she might be the first to agree with you that these “dopamine differences” deserve further study for full implications.

In the meantime, though, we face a society that is often science-ignorant, so we need solid proof that ADHD-related challenges aren’t all a matter of willpower, etc.

Interesting times we live in!

However I still reluctantly have a problem with calling this abnormal. Even if there is a smaller number of dopamine receptors in people with ADHD symptoms who is to say that this is wrong. I understand that the behavior this difference creates causes problems for people, myself included, but perhaps we havent fully explored the benefits of this difference.

It reminds me of Pavlov’s Dog and classical conditioning. Perhaps there is a reason not everyone is easily motivated by rewards and punishment. Any type of medication or treatment that would increase the dopamine receptors could easily be used in a retraining or reprograming scenario.

I know there are more issues here and I would love nothing more than for them to find something which alleviates the damage caused in peoples lives by ADHD. It is important research like this that keeps us moving forward.

If I weren’t rushing to speak at several ADHD-related fundraisers, I would try to put this study in context. Perhaps when I return.

There is a large body of evidence that explains ADHD neurophysiology. But this study by superb scientist Nora Volkow definitely kicks it up a notch.

gina