Not ADD? then it could be ODD!

[Cyrinne]

Oh, I absolutely agree! The reason I suggested discussing options with a pediatrician is because that is the FIRST step. Most insurance companies will require a referal from a pediatrician in order to cover any visits to a child psychiatrist for ADHD evaluations. And anyone who is going to want to consider medication as an option at any point, does want a psychiatrist and not a psychologist, because they will have the ability to write prescriptions for. Otherwise working parents could find themselves managing several different doctor appointments, some for therapies and some for medications, and that can be a real nightmare.

A good psychiatrist will spend a long time with a child before making any diagnosis like ADHD. He'll use the Connor's scales as only -part- of that diagnosis, but also likely do some diagnostic testing in his office, as well as just general therapy sessions. There are many who are specialists in this area and know about alternative strategies for working with children whose parents want to explore them before using medication. Good peditricians will probably be able to refer a parent to the best in their area.

[Cyrinne]

As to Oppositional Defiant Disorder, which was the original topic of this thread...yes it sounds like any typical teenager when you read the snippet posted here. What should be kept in mind is that ODD is something that is more typically diagnosed not in teenagers but in children aged 6-13. Teenagers who have these same issues are more likely to be diagnosed with Conduct Disorders under the DSM, which ODD is said to 'grow into' without treatment. ODD has also been linked in recent studies with post-traumatic stress disorder.

As for whether or not it is real...I can't speak for every case. But I know at least one case in which it was. When I was student teaching I knew a little boy who could not handle changes. He'd had an extremely stressful life, his father had been sent to prison the year before for and had died in jail. His uncle who had been taking care of him had recently been arrested himself, so his life was filled with high stress events for a seven year old. His mother was kind and loving and disciplined him as well as she could on her own, so the classic 'bad parenting' stamp that people would like to put on defiant children simply won't go. He had simply had a life too stressful for a small child to bear, and could not handle a life with lack of control. He threw huge tantrums in the classroom. I had to dodge a chair once. I don't blame him, and I don't blame his family. Sometimes the world is hard for children.

The DSM isn't perfect, nor are the means by which the school systems or even the medical and insurance systems have to 'label' students and patients in order to get them services and or medications. But a disorder is just that, something out of the ordinary. It is not normal to throw chairs when something doesn't go your way, and when a doctor is seeing a patient for having that problem, they have to be able to say what they think is going on. They have to code it for the bill for the insurance company, just like your physician would have to code bronchitis or influenza. And when kids were acting in a severely DIFFERENT way then they were with ADHD (kids who can't concentrate on tests do not often throw chairs) they needed a new way to identify that.

If you're interested in reading more about kids who 'act out' in general, and a WONDERFUL way to manage that without using medications, there is a book that I absolutely adore, by a doctor out of Boston who I've trained with and think is brilliant.

It's The Explosive Child, by Dr. Ross Greene (catchy title, eh) The methods may seem radical at first, but they have worked every time I've used them.

Here's the amzon link.

http://tinyurl.com/5krva

[Cyrinne]

Care to take a glance at the "about me"
section on Kati's link?

This doctor doesn't know anything about ADHD, ODD, or anything his website is about, at all. His expertise is anti aging medication. Quite a resource for that informative article.

Those of you with real interest in the topics may wish to consider other sources.

[drasoini]

Wow. Thank you Cyrinne. For being open about your own experiences, as well as for providing a serious amount of useful and insightful information. I just had to say it, sorry for going off topic.

[Grantref]

Wow. I look at my rant and compare it to cyrinne's posts and it really puts into perspective what I should have written instead. I definitely should not have said what I did, and I apologize to everyone.

There's a line between a passionate but reasonable response, and an angry, inappropriate rant, and I obviously crossed it.

[Dalaena]

Thanks for your apology, Grantref. It takes a good person with guts to be able to publically apologize after making a mistake. It makes it easier to move on from there.

[Grantref]

I'm going to try posting my thoughts on this again in a more reasonable fashion.

Seeing ADD and other disorders described as a 'scam' or a 'joke' tends to upset me, to put it mildly. I didn't struggle through half my school career, and my parents didn't struggle with me to get me to focus on my schoolwork, because of a scam. The psychologist who diagnosed me used the professionally accepted diagnostic critera to test the degree of my aptitude for paying attention, long- and short-term memory under conditions of distraction or no distraction, and found that I had a systematic bias toward consistently, significantly poorer performance on the tests requiring attention and focus than average people of the same age. I didn't imagine the improvement that I felt after taking Ritalin. My grades didn't go up by themselves. The crash-and-burn I experienced in college after deciding that I didn't need Ritalin anymore didn't happen by itself. The improvements in my relationship with Yelena and in my job when I take Ritalin aren't the results of a drug company fleecing me into paying out for their products.

Yes, there is a tendency to overdiagnose it, and parents should take the diagnosis of teachers and guidance counselors with a hefty grain of salt. There is also a tendency of our culture to cause a tendency towards attention-lacking behavior among individuals with no inherent ADD, and changing the setting for such an individual will frequently result in a great improvement.

Profits from Antibiotics, anti-cancer drugs, anti-HIV drugs, and pretty much any other drug out there are hefty too. One can't paint psychologists with a brush like that without tarring a lot of other medical problems too.

Ritalin is a stimulant, chemically related to methamphetamines. Overmedicating non-ADD children with it will not produce a zombie-like state. In ADD individuals, the portion of our brains dedicating to supressing impulses, coordinating trains of thought, maintaining focus of attention, etc. functions at a slower rate than normal. Ritalin, like caffine and other stimulants, 'wakes up' this portion of the brain and allows us to control our impulses, thoughts, and focus better. This is the same reason why children are frequently hyper when tired -- the portion of their brain that controls impulsivity is fatigued and not functioning well. The same reason is why drunks act on impulse -- alcohol, a depressant, impairs that suppresant function of the brain.

In regards to my earlier anger, I suspect that this is one of the points that set me off:

Katidyd wrote, in response to "Are you saying that ADD/ADHD is a quack diagnosis?"

YES! because the "symptoms" are natural stages in children. In the hectic schedule of parent/s it can be easy to fall into the drug solution as a problem of convenience. Drug your kids, keep them docile rather than dealing with what kids do when they are kids. There is huge money to be made and the drug companies push it on overworked parent/s. It's easier to prescribe drugs than social/parent skills.

The tendencies of ADD do occur in many children, however the key point in all of the diagnostic criteria in the DSM and other professional guidelines is that the person must suffer from these symptoms to a much greater degree than the typical person of their age. It is normal to pass through a period during one's childhood in which one is highly distractible -- I can see that in my daughter quite obviously. However it is not normal for a 15 year old to be as distractible as the average 5 year old. If they are, it is as strong an indication that something is wrong as if a 15 year old had the same reading ability as a 5 year old.

Again, Ritalin and other ADD medications are not sedatives. They are stimulants that in a non-ADD child, will probably cause approximately the same effect as caffine. In the amounts prescribed they are not harmful. Obviously it makes no sense to medicate those who it will not help, but it's a far cry from turning them into 'zombies'.

I would highly recommend Dr Hallowell's books on ADD if you want to gain real information on this matter. One that I found particularly helpful was Answers to Distraction, which is presented in a FAQ format which should be easily understandable to most people.

[Rosuav]

Grantref, I was one of the ones who considered it scammy too. The issue is not the few people, apparently including you, who have a real problem. The issue is the borderline people.

The tendencies of ADD do occur in many children, however the key point in all of the diagnostic criteria in the DSM and other professional guidelines is that the person must suffer from these symptoms to a much greater degree than the typical person of their age.

Therefore, ADD is defined as extremes of behaviour. Extremes of what is otherwise normal and expected. Looking at distractability, for instance:
* Some people are able to focus on a task easily. They're not diagnosed with any disorder, and all is well.
* Some, for whatever reason (it may be genetic, if your daughter is displaying the same tendencies), are completely unable, or find it very difficult to, concentrate. These people are diagnosed accurately, a prescription is made out, and drugs take the place of individuality to an extent.
* But it's those in the middle who are in question. My younger brother is distractable enough to get yelled at, but if he decides to put his mind to his work, he can concentrate decently and get work done.

Most people in the third category don't need drugs of any sort, they just need motivation to get cracking. When I say that ADD is largely a scam, what I mean is that many of those labelled ADD are the doubtfuls, where drugs aren't required.

Now, second category people still could be who they are, without drugs, simply accepting the fact that they are distractable - and making use of it. Perhaps this lack of focus results in an ability to see everything in a room at a single glance, and memorize it all. Or perhaps such a person can look at a problem from non-obvious angles, and find a solution that more focussed people have overlooked. However, if you want to fit in with a school system that basically requires that you concentrate on 'this' task now, 'that' task later, you'll do badly, and that's where drugs may be of value.

I'm not running down the few who have real difficulties that cannot easily be overcome (though I'd run down the System that causes the difficulties - run it down with a steamroller), but for all the people who just can't be bothered trying, and just seek drugs for their students (or their children, as the case may be), that's what I object to.

[Cyrinne]

I think there are several people here who are defaulting to a common misconception that there is any benefit to medicating children who do not have ADHD with stimulants in order to get 'better behavior' either at home or in the classroom.

Ritalin and all of the drugs in the same family used to medicate ADHD, with the exception of one, are amphetamines. The effect they have on a child without ADHD is much the same as giving that child several cups of coffee. There is no benefit for teachers or parents to seek to medicate any children who do not truly have this condition in order to modify behavior. It would very likely in fact, bring the opposite effect.

[Cyrinne]

While I have my own criticisms of the bureaucracies in question, I do think it's important to look at what they are doing and saying about a problem. In addition to the link that this thread was started with, I thought it might be helpful to share things written by credible sources. Despite whatever biases some feel they have in the matter, it's clear that research is being done on every level to find out more about these conditions and how to support children with them.

Here then is some work from the American Medical Association, The American Psychological Association, The National Initiative for Children's Healthcare Quality, and the National Education Association. All advocate working extensively with psychologists, doctors, and teachers before treatment or medication. All suggest alternative methods of working with children both at home and in the classroom beyond simply having them pop pills. All address the concerns that some parents have voiced in these threads. Three of them also seperately reference new research in neurology which is making it clearer to doctors and scientists the actual physical differences in brain chemistry and physiology that cause ADHD. Making it so that eventually perhaps no subjectivity will be involved in correctly diagnosing the condition.

http://www.ama-assn.org/ama/pub/category/12868.html

http://www.apa.org/ppo/issues/pchilrit.html

http://www.nichq.org/resources/toolkit/

http://www.nea.org/teachexperience/sped040206.html