PhD/PsyD Another "Adult AD/HD" article

[erg923]

Do You Zone Out? Procrastinate? Might Be Adult ADHD

Or....

1. Undiciplined
2. Lazy
3. Both
5. Prone to impulsiveness and poor decisions
4. Not socially skilled, or dont care to be.
5. Anxiety/anxious
6. etc.

I think "AD/HD" might be like number 10 or 12 on that list, if that. But, we have an interest in all this, so its ok to delude ourselves and society.

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[WisNeuro]

Well, those are terribly non-specific "symptoms." Especially considering some are actual symptoms or comorbidities of ADHD. Overdiagnosed, of course, but it's not like ADHD magically disappears in people once they turn 18. Adult onset ADHD , on the other hand, that's junk.

 

[erg923]

Well, those are terribly non-specific "symptoms." Especially considering some are actual symptoms or comorbidities of ADHD. Overdiagnosed, of course, but it's not like ADHD magically disappears in people once they turn 18. Adult onset ADHD , on the other hand, that's junk.

I agree. Was just commenting on how the title of the article, as well as much of the article itself, portrays or suggests (at least to the lay public reading it) that AD/HD is the most likely culprit for these symptoms. That notion is of course utterly ridiculous.

 

[WisNeuro]

I agree. Was just commenting on how the title of the article, as well as much of the article itself, portrays or suggests (at least to the lay public reading it) that AD/HD is the most likely culprit for these symptoms. That notion is of course utterly ridiculous.

Meh, they do it for everything, just look at screeners for just about any psychiatric disorder. If we relied on these types of things, 80+% of people would be diagnosable

 

[BuckeyeLove]

somewhat on topic: If you have enough available evidence (i.e., school records/report of parents/etc...), what's the consensus on retrospectively proffering an ADHD dx?

 

[WisNeuro]

somewhat on topic: If you have enough available evidence (i.e., school records/report of parents/etc...), what's the consensus on retrospectively proffering an ADHD dx?

With that and a good interview consistent with symptoms, sure. Plenty of people with actual ADHD go through school without ever getting an eval or diagnosis.

 

[erg923]

somewhat on topic: If you have enough available evidence (i.e., school records/report of parents/etc...), what's the consensus on retrospectively proffering an ADHD dx?

Are you doing a "psychological autopsy." That term always cracked me up.

 

[WisNeuro]

Are you doing a "psychological autopsy." That term always cracked me up.

Hopefully not. Not sure what doing all that work to diagnose ADHD in someone who is dead is worth it.

 

[erg923]

Hopefully not. Not sure what doing all that work to diagnose ADHD in someone who is dead is worth it.

I'm sure an attorney could think of reason.

 

[Therapist4Chnge]

Adult onset ADHD , on the other hand, that's junk.

According to dozens of bad referrals and a bunch of lawyers...ADHD can happen as an adult, especially following a mild concussion. #AlternativeFacts

 

[WisNeuro]

According to dozens of bad referrals and a bunch of lawyers...ADHD can happen as an adult, especially following a mild concussion. #AlternativeFacts

Adult onset ADHD, likely etiology service connection/litigation induced.

 

[Therapist4Chnge]

If hit by a company truck or while driving a company vehicle....exponential increase in the prevalence rate....

 

[smalltownpsych]

Do You Zone Out? Procrastinate? Might Be Adult ADHD

Or....

1. Undiciplined
2. Lazy
3. Both
5. Prone to impulsiveness and poor decisions
4. Not socially skilled, or dont care to be.
5. Anxiety/anxious
6. etc.

I think "AD/HD" might be like number 10 or 12 on that list, if that. But, we have an interest in all this, so its ok to delude ourselves and society.

My question is how far do you have to dig to find the profit motive behind this. Love the fact that it's being promoted as if it is a public service message.

 

[deleted760483]

Or:
Depression
Anxiety
Chemical abuse/dependency
An eating disorder
PTSD
Acute life stressors

 

[erg923]

Or:
Depression
Anxiety
Chemical abuse/dependency
An eating disorder
PTSD
Acute life stressors

I forgot to mention our obsession with "smart phones."

 

[smalltownpsych]

The WHO Adult ADHD Self-Report Scale for <i>DSM-5</i>
I didn't have to dig very far. Funded by Eli Lilly who sells Strattera.

 

[psychRA]

Plenty of people with actual ADHD go through school without ever getting an eval or diagnosis.

Absolutely. There are a lot of factors that influence the likelihood that someone with ADHD will even be assessed in childhood: being inattentive (hyperactive kids are often disruptive and therefore more likely to come to clinical attention); being in a larger school/larger school system; being in an underfunded public school system that doesn't have the bandwidth to assess kids who aren't hugely disruptive; having parents who have the knowledge, time, attentiveness, and resources to get their kid assessed; being male (ADHD girls are less likely to diagnosed as kids); having the intellectual resources to develop sufficient compensatory strategies to 'get by' despite the fact that you're underperforming relative to your abilities, etc...

I could go on for a bit longer, but there are many reasons why not being diagnosed in childhood isn't sufficient evidence to rule out a diagnosis in adulthood.

 

[Sanman]

Chronic sleep deprivation. The largest co-morbidity I see. I can't count the number of people that ask about adhd that get 4-6 hrs of sleep a night or less at times.

 

[AcronymAllergy]

It's of course important to note that ADHD could be comorbid with the above-mentioned factors. But I agree, there are often a dozen other explanations for attention/concentration problems. Building on sleep deprivation, I'd also throw in undiagnosed/untreated sleep apnea. And med effects (especially benzos and opiates).

 

[smalltownpsych]

Amazingly, they also found that the estimated incidence rate was 8.7 percent of the population. Who knew that there were that many people who have this horrible affliction. In addition to Eli Lilly who appeared to be the main driver of this study but there was involvement from a number of other pharmaceutical companies including Shire pharmaceuticals who funded the development of the DSM-V screener they were testing in the study. They make adderall and vyvanse "Ask your doctor if speed might help you perform better." Should I just get a rubber stamp for when these patients are referred for an ADHD evaluation? Oh wait, if I did that, my license is on the line for the few bucks I make because I am the one that is supposed to prevent the inappropriate use of prescription drugs. Meanwhile, they are making billions off this. I should just start up an ADHD clinic so I get my hand in the pie.

 

[Therapist4Chnge]

I should just start up an ADHD clinic so I get my hand in the pie.

Sadly, this happens every day....and even more so for things like concussion.

I wanted to make a snarky comment bc the tail (Big Pharma)...yet again...is wagging the dog (gov't).

 

[Sanman]

Should I just get a rubber stamp for when these patients are referred for an ADHD evaluation? Oh wait, if I did that, my license is on the line for the few bucks I make because I am the one that is supposed to prevent the inappropriate use of prescription drugs. Meanwhile, they are making billions off this. I should just start up an ADHD clinic so I get my hand in the pie.

Sadly (or luckily depending on your ethical proclivities), shoddy work will rarely get your license pulled. I have looked at my state licensing board complaints and you are one likely to get reprimanded for being late on CEs.

 

[Fan_of_Meehl]

Instead of publishing this stuff, NPR would better serve the public with an article on the application of a couple of related concepts from the philosophy of science (and their application to psychopathology and differential diagnosis):

The underdetermination of theory by evidence (the 'under-determination problem') and

Underdetermination - Wikipedia

The fallacy of affirming the consequent

Affirming the consequent - Wikipedia

If the public were more educated on these concepts, we'd all be a bit better off.

 

[cara susanna]

Can I jump on this topic and complain about all of the mainstream coverage of service dogs for PTSD and how everyone with PTSD should get one? Ugh.

 

[smalltownpsych]

Sadly (or luckily depending on your ethical proclivities), shoddy work will rarely get your license pulled. I have looked at my state licensing board complaints and you are one likely to get reprimanded for being late on CEs.

I know. It's just my way of expressing my feelings of frustration about striving to maintain a high ethical standard when other more powerful organizations are just trying to make a buck with little or no ethical responsibility. Nevertheless, when there is a problem because too many people are being negatively affected by increased access to these medications, who do you think they will blame? Just look at the current problem with prescription opiods and how vicodin was originally marketed as a safer, less addictive opiate and how pain was the fifth vital sign that was being under-treated and now we have to try to get these patients off of these medications (except for the ones who already died of suicide or OD or combination thereof). The companies already made their money though and they face absolutely no repercussions unless there is a price to pay in the hereafter.

 

[Fan_of_Meehl]

I know. It's just my way of expressing my feelings of frustration about striving to maintain a high ethical standard when other more powerful organizations are just trying to make a buck with little or no ethical responsibility. Nevertheless, when there is a problem because too many people are being negatively affected by increased access to these medications, who do you think they will blame? Just look at the current problem with prescription opiods and how vicodin was originally marketed as a safer, less addictive opiate and how pain was the fifth vital sign that was being under-treated and now we have to try to get these patients off of these medications (except for the ones who already died of suicide or OD or combination thereof). The companies already made their money though and they face absolutely no repercussions unless there is a prove to pay in the hereafter.

Similar issue with the 'caregiver support' program ($2000 / month tax-free payments + health insurance coverage for stay-at-home spousal 'caregivers') for primary mental health disorders (PTSD, depression) in the VA system.

I can find no source in the respectable professional literature that it is standard of practice to recommend a monthly stipend (so that the spouse can stay home and 'care-give' to the patient suffering from depression or PTSD) as a 'treatment' or 'management' component for addressing these mental disorders.

Now, the VA is realizing that this was a bad idea (nobody is coming off of these programs) so they are--in certain geographical areas--'pulling people off' caregiver support programs, and there is the obvious public relations uproar (and newspaper articles).

They're also in a bind because the same rationale they used to place people onto the caregiver support program (to 'qualify' them for it)--namely, that they have a condition such as PTSD/depression as well as significant self-reported symptoms of same--well, guess what...they still report serious symptoms of PTSD/depression as well as functional impairment from said symptoms. This makes the 'decision' to pull them off the program appear (as it is) arbitrary at this point in time.

Whenever people ask me about it as a clinical psychologist I always reply that giving someone 2 grand tax free monthly payments is not a recognized 'treatment' or 'management' strategy (within my field) for addressing conditions such as depression or PTSD in adults.

 

[WisNeuro]

Similar issue with the 'caregiver support' program ($2000 / month tax-free payments + health insurance coverage for stay-at-home spousal 'caregivers') for primary mental health disorders (PTSD, depression) in the VA system.

Want to guess what my current PVT failure rate is for people coming in for a cog eval appealing a decision or referred prior to getting approved?

 

[Fan_of_Meehl]

Want to guess what my current PVT failure rate is for people coming in for a cog eval appealing a decision or referred prior to getting approved?

94%?

 

[WisNeuro]

Very close, 100%.

 

[Sanman]

Very close, 100%.

Curious, what is your overall PVT failure rate?

 

[WisNeuro]

Curious, what is your overall PVT failure rate?

When I checked last week, 44%

 

[psych.meout]

Want to guess what my current PVT failure rate is for people coming in for a cog eval appealing a decision or referred prior to getting approved?

What are their responses when you give feedback about their PVT failure and overall assessment results?

 

[WisNeuro]

What are their responses when you give feedback about their PVT failure and overall assessment results?

Short answer, it depends. Did they fail validity measures, but still are well within normal limits on other measures? Did they bomb all testing? Are they below chance performance, etc. The feedback varies a lot, and the response varies a lot. The slammed door and storming out is surprisingly rare, though.

 

[jmiah717]

Similar issue with the 'caregiver support' program ($2000 / month tax-free payments + health insurance coverage for stay-at-home spousal 'caregivers') for primary mental health disorders (PTSD, depression) in the VA system.

I can find no source in the respectable professional literature that it is standard of practice to recommend a monthly stipend (so that the spouse can stay home and 'care-give' to the patient suffering from depression or PTSD) as a 'treatment' or 'management' component for addressing these mental disorders.

Now, the VA is realizing that this was a bad idea (nobody is coming off of these programs) so they are--in certain geographical areas--'pulling people off' caregiver support programs, and there is the obvious public relations uproar (and newspaper articles).

They're also in a bind because the same rationale they used to place people onto the caregiver support program (to 'qualify' them for it)--namely, that they have a condition such as PTSD/depression as well as significant self-reported symptoms of same--well, guess what...they still report serious symptoms of PTSD/depression as well as functional impairment from said symptoms. This makes the 'decision' to pull them off the program appear (as it is) arbitrary at this point in time.

Whenever people ask me about it as a clinical psychologist I always reply that giving someone 2 grand tax free monthly payments is not a recognized 'treatment' or 'management' strategy (within my field) for addressing conditions such as depression or PTSD in adults.

You mean over accommodate the symptoms of the disorder, which much of the recent studies say actually makes the disorder worse and less likely to be amenable to intervention? Agreed. I have a friend who works at a UCC and said, jokingly (sort of), that she thinks she ought to start a "bring back the stigma" campaign because she thinks people are too quick to reach for therapy to solve the simplest of life's problems.

Her greater point (an overall lack of resilience) is worth further inquiry, in my experience. As a vet who serves other vets, I'm all for people getting what is needed to get them back on their feet and succeed....I think we've long passed that marker though. We've created another dependency system, especially in rural Pennsylvania where I reside. It creates no incentive for someone with little to no marketable skills, some pre-existing MH issues prior to service/family dysfunction to actually get well......why say you're doing better? You'll end up dirt poor with no job prospects.

Coming to the VA for your occasional check up at intervals that aren't even effective just to check the box and show the reviewers (see, still in therapy)...sigh...more succinctly...I agree with you.