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ADD: How Dx is Made

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Have you ever wondered how the powers that be determine whether a kid is ADD/ADHD or not?  How do they know…like are there specific tests or markers, an ADD litmus of sorts?  Because remember from last post, the predominant “health” paradigm in the world today is a mechanistic medical model–there’s usually a physical problem–so shouldn’t there be distinct physical evidence?  In the next two posts we’ll investigate each one of these questions as well as consider another, perhaps better, way of looking at things.

To be diagnosed ADD/ADHD, a child has to exhibit particular behaviors for an extended period.  Because a number of other disorders have similar (if not exactly the same) symptoms as ADD, it’s important for the diagnosing doctor, school nurse, teacher or principal (ya don’t think so?…then I’ve got a bridge to sell ya…) to be able to differentiate between this behavior disorder and all others that cause lack of focus.

Yes, that’s right, I said a behavioral disorder.  That’s a crucial distinction to be made for ADD; in other words, NO PHYSICAL MARKER–no specific test or neurophysiological change that can be measured, just the observation of a professional.  Don’t worry, medical science is working hard to find that marker.  And as I always say, “If you look hard enough, you’re bound to find something.”  But, I know, you’d think after more than 100 years, and being the best studied disorder in all of medicine that, well…

The signs necessary to classify a child (or adult) as ADD are the following (six or more must be present for at least 6 months to a point that is disruptive and inappropriate for the developmental level):

  • Inattention:
  1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  2. Often has trouble keeping attention on tasks or play activities.
  3. Often does not seem to listen when spoken to directly.
  4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  5. Often has trouble organizing activities.
  6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  7. Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
  8. Is often easily distracted.
  9. Often forgetful in daily activities.

For hyperactivity-impulsiveness (six or more must be present for at least 6 months to a point that is disruptive and inappropriate for the developmental level):

  •  Hyperactivity:
  1. Often fidgets with hands or feet or squirms in seat.
  2. Often gets up from seat when remaining in seat is expected.
  3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
  4. Often has trouble playing or enjoying leisure activities quietly.
  5. Is often “on the go” or often acts as if “driven by a motor”.
  6. Often talks excessively.
  • Impulsiveness:
  1. Often blurts out answers before questions have been finished.
  2. Often has trouble waiting one’s turn.
  3. Often interrupts or intrudes on others (example: butts into conversations or games).

Interestingly, these are the criteria used in the U.S.; they come from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).  In Europe, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is used instead.  According to one review, use of the DSM criteria increases the likelihood of an ADD diagnosis 3-4 times more than if the ICD-10 is used.

And what causes ADD…according to the current model, that is?  Well, no one really knows for sure.  Here are a few existing theories:

  • Genetics: Researchers believe that a number of genes may be implicated in the cause of ADD; but alas, with the sheer numbers so high, they admit it doesn’t follow the typical pattern of a “genetic disease” and thus must instead be a complex genetic/epigenetic interaction.  Sigh, always the genetic explanation when things don’t add up.  I always say, “Genetic cause means ‘we just don’t know!'”
  • Hunter vs. farmer theory: the idea that hyperactivity may actually have evolutionary advantages.  So back when man was a doltish hunter, hyperactivity likely served him.  As he moved into more intelligent means of survival (read: farming), requiring more complex tasks, he shed his hyperactivity trait.  People with ADD contain a sort of vestige of this once useful trait.  Uh…any of my hunter readership like to comment on this harebrained hypothesis?
  • Environmental: Cigarette smoke, head injuries, toxins, pesticides, organophosphates, global warming, blah, blah, blah, blah, blah…
  • Diet: Artificial foods, preservatives, food coloring, blah, blah, blah, blah, blah…
  • Social: Family dysfunction, child abuse, inattentive parents, time in orphanages.
  • Neurological: Underdeveloped neurological pathways, and the list goes on…

In all of this, the pathophysiology (the functional changes) of ADD remain UNCLEAR!!!  Did I get that point across strongly enough?  Many signs, many symptoms, no consensus, many theories…but no clear-cut evidence.  Frickin’ duh!!!  Part 2 tomorrow.

ADD: Another Notch on the Medical Model

By On · Add Comment · In Body, Mind


So we have discussed the history of ADD, but how does a disease or disorder become established as an entity?  This is an important question because it determines the course of a disorder historically, sociopolitically and economically.  But most important, it determines how diseases/disorders become etched into the human psyche.  Think this doesn’t play a massive role in human health?  Think again.

The current health paradigm that predominates today is the medical model.  It would take more than just a few paragraphs to do the subject justice (if you are interested, I highly recommend my book, The Six Keys to Optimal Health), but I can give a brief synopsis here:

Modern medicine views the human body mechanistically–like an intricate machine.  Just as a machine can be broken down into ever smaller parts, so, too, can the human body.  By studying and mastering the workings (physiology) of the parts (systemic anatomy), we can understand the operation of the whole.  Simple.  When the parts start to malfunction (pathology), we can address them…cure them…through medicines (pharmacology) and/or removal (surgery).  Fair enough.  I find it flawed, but…as far as strategies go, it’s not bad.

But wait, it gets better.  Because we are physical beings in a material existence, then all problems related to our physical bodies have to have a physical basis.  Yes, even mental ones.  Because at our core we are simply neurophysiological life forms.  And when we break down human beings to their most fundamental parts, we are just electrochemical processes doing their thing.  It’s all rather Maxwellian.  Simple physics.

Physical problems, then, should have physical solutions, and throughout much of medicine’s short history, the victories have been rather awe-inspiring: Mass infectious epidemics have been nearly conquered; emergency medicine now saves lives that would have be long lost even fifty years ago; human prosthetics are damn-near perfect; even our increased life span is often credited to the wonders of modern medicine.

So what?  What does this have to with ADD?  Well, medicine did something peculiar…it started targeting what it considered “normal” physiological processes gone awry–things like cholesterol levels, and impotence, and symptoms of the common cold; it even started in on normal mental states like depression and well, fidgeting.  Yes, anything that could be considered a deviation from the norm was fair game.  The inability to focus in a schoolroom setting, then, was ripe for medical intervention.

It is interesting how unwanted (and unappreciated) physical and mental states become established as disorders.  First, they are recognized and their symptoms recorded, and then a profile of the most commonly afflicted is noted.  The disorders are then given a name, but over time, more symptoms are added, some possibly subtracted, but then re-added again, and the parameters stretch outward inch by inch.  As the definition of the disorder expands, more and more people are labeled with it, and the growing numbers are then called an epidemic.  Epidemics demand solutions, and in our mechanistic medical model this usually means drugs or surgery (think swine flu and carpel tunnel syndrome respectively).

Once somebody is labeled with a disease or disorder, the inclination of the human mind is to identify with it.  The person becomes the disease:

Hi… I’m Nick and I’m an alcoholic (now a disease, too).  Hola, me llamo Jesus: yo tengo blue balls (it’s coming [figuratively speaking]…swear).  Greetings, my name is Fenster P. Finkleschitkid, and I’ve got AD…hey, that’s my toy!!!

And they are never short of support.  Medical science supports them, doctors and therapists support them, society and it’s numerous special interest organizations support them, and of course, their loving families support them, because well…it’s a disorder you see, and we…just…want them…to have…normal….lives (whatever the hell that is).

ADD is no different.  It’s just one of many, many diseases and disorders that gets big money to study (remember, it’s the “best studied disorder in medicine”) and support all the intricacies (the changing ones) tied up in the horrible scourge.  And, of course, when they get their own drug treatment, they hit the big time–it all becomes official.  The AMA then takes a position on it and it becomes etched into the consciousness for all time.  Hallelujah!  Praise Hippocrates, we did it again.  Thank you, thank you, thank you (pat on the back)…and on to the next one.

Next post I’ll offer a better solution.

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