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Son, you have no idea how wrong you likely are. Good luck with the attitude, grad school, and life in general won't be easy for you.
Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder?
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Son, you have no idea how wrong you likely are. Good luck with the attitude, grad school, and life in general won't be easy for you.
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I guess I just dont get your beef, here? You want to blame "the field" for not "catching" your manipulative friends????
Psychologist who are in treatment roles are not here to be lie detectors. If you want help, Ill help you. That's my job. Again, this is not a field with labs and biomarkers. Make your peace with it now, or dont go into the field. Your griping doesn't help.
Regarding interview, history and collateral, I dont get your beef with this either? This is essential components of any healthcare practitioner. Your obsessive focus on is fallibility isnt allowing you to see its benefits.
I appreciate the lack of respect.
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I appreciate the irony of your statement.
It's not a beef. I'm just saying if we are talking about "nuance" in assessment/diagnosis..at least in regards to anxiety disorders..is largely a fallacy. Let's just not pretend there is so much to know to diagnose someone properly..when as Meehl said in many cases "it's mixing a story or set of info in your head" and coming to a conclusion. It's not accurate. It seems comprehensive, and it is, but not in the way that would get you to a correct diagnosis.
I don't disagree that these people have issues nevertheless and need some level of help.
Well, you're the one saying that your training has helped you become a true professional. I made no such statement.
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So...diagnosing GAD isnt technically akin to rocket science or brain surgery. Again, your point is lost on me?
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uh-huh...
So this is you not claiming to be an expert on diagnosis and treatment....
I hope that at some point you learn some humility and take some time to reflect upon some of the information provided to you from real professionals with dozens of years of experience who have taught more classes than you have attended as a student.
Doubling down on the bravado is not a great approach to most things, particularly when it comes to higher education. You will get laughed out of an interview if you take this same approach, and that's the best case scenario. No mentor would put up with such an insulting approach to out field.
I'm sure you'll ignore this feedback like most of the other posts in this thread, but hopefully it will help other undergrads not make the same mistakes in their pursuit of learning in this field.
Other prospective students...insulting professionals and claiming to know more than them is not the best approach to get ahead. It should probably go without saying, but just in case...
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You have not at any point answered why i'm wrong..you keep deflecting. Why am I wrong on how anxiety is diagnosed?
So far, my impression of how you train students is to tell them to stfu because you're the expert, and they are not. or to deflect. Is this how I become a rock solid Clinical Psych? Student asks question, or makes a statement, and I just tell them "you're not an expert..I am".?
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Mama Ph.d already answered this as best as can be summarized in a paragraph (as opposed to other ancillary knowledge about psychopathology and experience with the process). But clinical diagnosis is a process and is not amenable to a text book learning no matter how much you may want it to be.
And yes, I do expect trainees to accept that I know more than them. I have the PhD and the license and you dont. Thats why you are the student and I am the teacher. When one cannot humble themselves to this fact, it gets in the way of learning and is bad for everyone who holds a stake in the outcomes. Especially patients.
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I know you know more..I'm suggesting that you may be in "too deep" to be open to criticism of the field. You've made a big investment, now you have to protect it.
You are right though, MamaPhd did make a great post and I remember reading it. Maybe I will quote her post and maybe respond with follow ups later.
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You seem to be hyper focused on the clinical vs actuarial work, and I'm not even sure you fully understand it cause i think you are misusing it within the context of clinical diagnosis. Alot of it had to with predictive validity of future behavior, not necessarily psychiatric diagnosis, although Codetypes generally worked out pretty well.
In reality, Meehl was huge proponent of descriptive psychopathology, loathed its slow death over the years, and went to the grave thinking that psychologists were hopelessly narrow-minded about what constituted empirical evidence. He remained a big proponent of Freud and "unprovable" Freudian concepts until he died.
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I think most feel you are not in deep enough to really know what your criticizing.
I def see this loud and clear. haha
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You are asking how to make a 5 course meal and you can't even make an omelet (traditionally the first dish assigned in a French culinary program). It isn't my job to prove you wrong.
You come out insulting the field and throwing out wildly inaccurate statements, and you expect me to what...treat you like an equal? Good luck with that approach.
Keep on tilting at windmills, as it has worked so well for you this far.
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This isn't a school or personal tutoring lesson on how to diagnosis/treat. I'm not here to discuss issues you believe are relevant (aka, non-issues) to the field. You do not have a sufficient knowledge base to do so. I'm here to help folks who have questions about their trajectory as students and to discuss field relevant issues with others in the field. Your criticism based on personal experience is empty and lacks evidence of validity and is not sufficient to warrant 'discussion'. Your other argument against what we are have said is also not based on evidence but suggesting that I (and others) have a bias which makes us wrong. In doing so ipso facto, you assume you are correct. Your arguments are against all evidence in the field. Period. You can claim public bias, experiential expertise, etc., but those are not scientific standards of proof.
Thus, your arguments and assumptions are insulting to a field that you don't know the first thing about.
Thus, your arguments and assumptions are insulting to a field that you don't know the first thing about.
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You mean, it would be the standard of practice for the field due to the amount of studying and information needed to perform the job competently?
Good point.
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Your professors in a masters program will have Ph.Ds. They will still expect you to communicate in certain ways.
I'm a delight in real life. I promise.
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"Mammography is widely used to screen for breast cancer. Most patients and even some doctors think that if you have a positive mammogram you almost certainly have breast cancer. Not true. A positive result actually means the patient has about a 10% chance of cancer. 9 out of 10 positives are false positives." Science-Based Medicine Harriot Hall
Expecting classic scientific laboratory generated bio-markers to be the gold standard for diagnostic evaluations has pitfalls. Beyond the errors inherent in this approach, they are less than perfectly accurate for other reasons as well.
People cheat or deceive on these kinds of tests, too. Substitute some one else's blood for your own or jiggle a little during a chest x-ray or thousands of other subtle manipulations can also be used to fool the experts. When clients see a professional for anxiety kinds of issues, there is a presumption of authenticity. Wishing that psychiatric illnesses are not real, bio-medical disruptions, doesn't make them invalid. If by studying the number of times a child gets up from his desk in a classroom is used as a baseline to establish normal childhood vs. ADHD behavior by advocates of the non-bio-marker school of thought, then exceeding that limit consistently and dramatically may also be used as a type of bio-marker.
Expecting classic scientific laboratory generated bio-markers to be the gold standard for diagnostic evaluations has pitfalls. Beyond the errors inherent in this approach, they are less than perfectly accurate for other reasons as well.
People cheat or deceive on these kinds of tests, too. Substitute some one else's blood for your own or jiggle a little during a chest x-ray or thousands of other subtle manipulations can also be used to fool the experts. When clients see a professional for anxiety kinds of issues, there is a presumption of authenticity. Wishing that psychiatric illnesses are not real, bio-medical disruptions, doesn't make them invalid. If by studying the number of times a child gets up from his desk in a classroom is used as a baseline to establish normal childhood vs. ADHD behavior by advocates of the non-bio-marker school of thought, then exceeding that limit consistently and dramatically may also be used as a type of bio-marker.
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Did you miss @psych844 most recent post in the John Jay thread where his current school has a PhD in clinical psychology program that doesn't require the GRE OR an interview?
Maybe it's a blessing the APA no longer accredits Canadian programs since Canada has a jacked up way of regulating mental health/psychology. Wonder if his friends/family who gamed the system were assessed by these lovely Masters level "psychologists" he claims are "competent" enough to practice independently at the Masters level? 
Did you miss @psych844 most recent post in the John Jay thread where his current school has a PhD in clinical psychology program that doesn't require the GRE OR an interview?
Your knowledge level about Canadian schools is at about 0%.
Almost all Canadian Universities are public research institutions. We don't have for-profit schools. If you look at the list of Canadian institutions that are APA accredited, or CPA accredited, you won't find one that is a private institution or for-profit. They are all public.
My University is big, and is a public-research institution. It has a medical school, and a law school, and does some of the top research.
I'm less competitive for the Phd program at my current school than I would be at others. My school is unique in their assessment of candidates. They place quality/amount of research (especially posters, publications), GPA, and research fit at the top of the list. You won't get into our school's Phd program without an 85-90% cgpa (so basically 3.8 or higher), and no chance if you've only done basic research. So they favor GPA, research quality/amount, and fit with faculty very highly. The faculty rate the candidates based on this criteria, but there is no formal interview.
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I did not mention for profit schools (they are shoddy programs) so I don't understand why you bring it up? The US has quite a few private (meaning NOT funded by state budgets) institutions that also have med/law schools...and top research. Again, what is your point? Your school's "unique assessment" of candidates is fairly standard for most non-FSPS, APA -accredited PhD programs in the US...PLUS an interview is required. To weed out the folks who think they know everything or aren't a good fit for training/program. If you interviewed at a school here, with the responses you have given in this forum, your chances of getting an offer would probably be low, especially given the competitive nature of applying.
You didn't answer my question about who assessed the "system-gamers", I noticed.
My response was to address this idiotic statement of yours. You were taking a shot at my school, and Canadian programs..yet Canadian standards for Clinical Psychology are much higher than American ones. It's objectivity harder to get into accredited Canadian programs, we don't have any for-profit schools around, we don't have small ****ty private schools that are accredited, and even the provinces that have Masters-level clinicians tend to have limitations on their practice/or these Masters level people did their program at well respected Canadian Universities.
"Did you miss @psych844 most recent post in the John Jay thread where his current school has a PhD in clinical psychology program that doesn't require the GRE OR an interview?
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Those people probably would have fooled me too. If somebody tells me they have anxiety, I believe them. Like erg said, as someone who is focused on providing treatment, why would I waste my time trying to figure out who is trying to game the system? Most importantly, it wouldn't help my patients who sincerely want help to be that skeptical of their claims.
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@psych844 , I had a bit of trouble discerning because of the ridiculous amount of off-topic criticism in this thread, but this seems to be one of the more important points that you are getting stuck on:
This is more of a problem with the disability system than psychologists' best practices, IMO. In many cases (with notable exceptions, e.g., forensic or disability claims-specific evals), it is just plain not the job of a psychologist to say with 100% accuracy whether someone is lying/exaggerating their symptoms. This is also true in medical evaluations in other specialties and is not at all unique to mental health. The goal is usually to help people, and we cannot focus all of our attention on whether or not someone is lying all of the time. However, regarding cases when it IS the specific job of the psychologist to help determine the validity of symptoms, sometimes they are not even able to use SVTs (or if they do, the SSA doesn't care and doesn't use this to determine disability status). For example, I know there has been a push over the past few years in the U.S. for the SSA to include SVTs in disability evaluations because right now THEY do not want them (or don't want to pay for them) in the psychological evaluations that they request. This may have changed or been updated recently, but I'd suggest you google this if you are interested. Point being, how the heck are psychologists supposed to prevent disability claims fraud if the govt doesn't even want us to use basic tools to help rule-out malingering? The burden cannot fall on psychologists completely when the system itself is partially broken. I'm sure other posters on this forum can speak to these issues more accurately than me though, so if others would like to offer clarification or dissenting opinions, please do so.
Re: objective tests vs clinical interviewing: Validity is an interesting and integral part of diagnosis (hence the use/interest in SVT/PVTs). However, these are tools that merely help to add to the clinical picture (perhaps a degree of certainty) in specific situations. These tests and other diagnostic indicators (objective testing, etc., whatever) are never 100% accurate. As erg has repeatedly reminded you, very little in this field ever is because of the enormous interactional complexity of what we are dealing with. Rather than continue to frame this as something to criticize, why not see it as a strength? We are studying and helping to treat incredibly complex and difficult things that will ALWAYS involve a degree of uncertainty. As a new student, this can be difficult to understand or accept, but I urge you to try to see this aspect of our field as a strength (e.g., the importance of a clinical interview, for instance, as being a more holistic approach to assessment) rather than a weakness due to a lack of "certainty" with "objective" measures. This admiration for "objective" testing is in itself flawed/dangerous because a lack of appreciation for ANY test's level of uncertainty can easily lead to over-reliance or misuse.
I hope you can learn to use the scientific skepticism that you seem to hold in such high regard in a more productive/proactive way. Right now it appears to be more of a hindrance to your professional development as evidenced by the attitude in your posts. I hope you can turn this around, as it will make any potential future studies in this field so much more eye-opening and beneficial.
This is more of a problem with the disability system than psychologists' best practices, IMO. In many cases (with notable exceptions, e.g., forensic or disability claims-specific evals), it is just plain not the job of a psychologist to say with 100% accuracy whether someone is lying/exaggerating their symptoms. This is also true in medical evaluations in other specialties and is not at all unique to mental health. The goal is usually to help people, and we cannot focus all of our attention on whether or not someone is lying all of the time. However, regarding cases when it IS the specific job of the psychologist to help determine the validity of symptoms, sometimes they are not even able to use SVTs (or if they do, the SSA doesn't care and doesn't use this to determine disability status). For example, I know there has been a push over the past few years in the U.S. for the SSA to include SVTs in disability evaluations because right now THEY do not want them (or don't want to pay for them) in the psychological evaluations that they request. This may have changed or been updated recently, but I'd suggest you google this if you are interested. Point being, how the heck are psychologists supposed to prevent disability claims fraud if the govt doesn't even want us to use basic tools to help rule-out malingering? The burden cannot fall on psychologists completely when the system itself is partially broken. I'm sure other posters on this forum can speak to these issues more accurately than me though, so if others would like to offer clarification or dissenting opinions, please do so.
Re: objective tests vs clinical interviewing: Validity is an interesting and integral part of diagnosis (hence the use/interest in SVT/PVTs). However, these are tools that merely help to add to the clinical picture (perhaps a degree of certainty) in specific situations. These tests and other diagnostic indicators (objective testing, etc., whatever) are never 100% accurate. As erg has repeatedly reminded you, very little in this field ever is because of the enormous interactional complexity of what we are dealing with. Rather than continue to frame this as something to criticize, why not see it as a strength? We are studying and helping to treat incredibly complex and difficult things that will ALWAYS involve a degree of uncertainty. As a new student, this can be difficult to understand or accept, but I urge you to try to see this aspect of our field as a strength (e.g., the importance of a clinical interview, for instance, as being a more holistic approach to assessment) rather than a weakness due to a lack of "certainty" with "objective" measures. This admiration for "objective" testing is in itself flawed/dangerous because a lack of appreciation for ANY test's level of uncertainty can easily lead to over-reliance or misuse.
I hope you can learn to use the scientific skepticism that you seem to hold in such high regard in a more productive/proactive way. Right now it appears to be more of a hindrance to your professional development as evidenced by the attitude in your posts. I hope you can turn this around, as it will make any potential future studies in this field so much more eye-opening and beneficial.
Thanks a lot for this well thought about post! You made a lot of great points.
I think there are a few things at play here for me.
1. I have some trust issues at a general level. The idea that someone is not being genuine, and is possibly trying to pull a fast one on me, bothers me.
2. I have many interests. One career option for awhile there was police work. I love mystery shows and detective work in particular. I just have this curiosity about knowing what happened. For quite a few reasons, going that route doesn't have that appeal to me anymore, but I still find the work very interesting. I see a bit of this detective work dynamic in Psychology, especially Forensic work...that is appealing.
3. Def a part of it is not having that blood test, x-ray, to more conclusively confirm a diagnosis.
The irony is that the "mystery" inherent in Psychology is a big reason for my interest in it. I see the field as mysterious, so I have a major curiosity to learn it, but don't have the training yet. It leads to frustration.
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This seem to be genuine reflective points/thoughts on your part. However, I would argue that number one is a serious issue in terms of going into the practice of professional psychology. One could argue that this make you a good fit for certain aspects of forensic practice, but I would not be one of them because the motive behind every assessment is to assess what's there, not to try to "catch" something that may or may not be there because you have trust issues and can't bear the thought of someone pulling the wool over your eyes.
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There is a notable movement in the field towards folks believing that blood tests and other 'medical' interventions will provide us very clear diagnositics. This is an over-simplification (unfortunately) for many reasons. I believe it reflects our insecurity as a field about not being 'sciencey' enough. Not only is personal experience not easily measured as different events vary in perceived intensity and relevance, but the larger issue (in my mind) is that we presume that medical diagnosis is simple, accurate, and that it does not suffer from similar problems. Par4thecourse provided a good example of that earlier on this page.
And I wholely agree with erg. Those issues of trust can lead to problems because the question you have to balance is "what is the best for my client" and part of that balance is determining relative risk. For instance, someone presents with some signs of ADHD for an evaluation asking for extra time on the GRE. They report symptoms, the testing reveals some evidence of related/expected deficits, and yet some symptom validity indicators do not entirely indicate "honest responding". What do you do? Do you assume malingering (a damning diagnosis) and conclusion that could force greater harm to the client... or do you determine that the extended test time is warranted? This is the real world of evaluation where there is no 'right' or 'wrong' and it rests on probability. There is an entire literature on PTSD symptoms, for instance, and how elevated validity scales on the MMPI may not reflect invalidity at all and merely a hyper-sensitivity to symptoms consistent with actual PTSD diagnosis. Please note, my referencing this literature does not suggest agreement on what elevated scales indicates and if such an approach is the 'best' or 'correct' one. It merely is an example to exemplify this problem. Plug that issue of elevated validity scales for PTSD into the context of a compensation evaluation at a VA, you're back at ground zero for 'difficult clinical determinations'. To me, and many others, the risk of not helping outweighs the risk of helping in many cases.
And I wholely agree with erg. Those issues of trust can lead to problems because the question you have to balance is "what is the best for my client" and part of that balance is determining relative risk. For instance, someone presents with some signs of ADHD for an evaluation asking for extra time on the GRE. They report symptoms, the testing reveals some evidence of related/expected deficits, and yet some symptom validity indicators do not entirely indicate "honest responding". What do you do? Do you assume malingering (a damning diagnosis) and conclusion that could force greater harm to the client... or do you determine that the extended test time is warranted? This is the real world of evaluation where there is no 'right' or 'wrong' and it rests on probability. There is an entire literature on PTSD symptoms, for instance, and how elevated validity scales on the MMPI may not reflect invalidity at all and merely a hyper-sensitivity to symptoms consistent with actual PTSD diagnosis. Please note, my referencing this literature does not suggest agreement on what elevated scales indicates and if such an approach is the 'best' or 'correct' one. It merely is an example to exemplify this problem. Plug that issue of elevated validity scales for PTSD into the context of a compensation evaluation at a VA, you're back at ground zero for 'difficult clinical determinations'. To me, and many others, the risk of not helping outweighs the risk of helping in many cases.
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I'm slightly over-exaggerating to make a point..but yes, I see your point.
it's not an issue day to day..I trust people, and i'm very empathetic and sympathetic..but I could see it being a problem 1% of the time if there are other stressful circumstances going on in my life. But I would assume this is somewhat normal for everyone? and in the least that the training should prevent something like this from creeping into the actual work?
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Although ADHD is a multifactorial disorder, disrupted dopamine (DA) neurotransmission plays an important role in its pathophysiology. In addition, polymorphisms in the dopamine D1 receptor (DRD1) are associated with the disorder (Misener et al. 2004). MPH and d-AMP both enhance DA signaling in the brain. MPH increases DA by blocking dopamine transporters (DATs) and AMP by releasing DA from the nerve terminal using the DAT as carrier (Kuczenski and Segal 1997). In healthy controls and in adolescents and adults with ADHD (Rosa-Neto et al. 2005;Volkow et al. 2007), MPH significantly increased DA in the ventral striatum (VS) (Volkow et al. 2012), a crucial brain region involved with motivation and reward (Wise 2002). Moreover, intravenous MPH-induced increases in DA in the VS were correlated with improvement in symptoms of inattention after long-term oral MPH treatment. Historically, the core feature of ADHD has been characterized as one of attention deficit, but increasing evidence suggests that a reward and motivation deficit may be of equal importance. It has been proposed that increasing DA in the VS would enhance the saliency of the task, thus improving attention in ADHD (Volkow et al. 2012). Intravenous MPH also significantly increased DA in the prefrontal and temporal cortices that were associated with decreased ratings of inattention, which may be therapeutically relevant.
Shaheen E Lakhan and Annette Kirchgessner
Brain Behav. 2012 Sep; 2(5): 661–677.
Published online 2012 Jul 23
Shaheen E Lakhan and Annette Kirchgessner
Brain Behav. 2012 Sep; 2(5): 661–677.
Published online 2012 Jul 23
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This reminds me of why I do so enjoy doing assessment with a largely non-verbal (and non-malingering!) population of toddlers.
Oh those toddlers..they are #1 on my suspicion list! Pretending to not be able to talk and all..they don't have me fooled...
😀
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Correct. Having an awareness of our own tendencies and biases and taking steps to mitigate them is an essential skill for a psychologist.
I think having that the desire to solve a mystery can be a great driver of the intellectual curiosity of an effective psychologist and it is part of what drives me. I can be almost obsessive in my need to understand what is going on with my patients. Even when they are lying to me, I still just want to figure out why.
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Highlighting this excellent point. Inattentive type may be overlooked in childhood because, unlike hyperactivity, it's less disruptive to the rest of the classroom environment. Because of this, inattentive type is even more likely to be overlooked in schools with larger class sizes/fewer resources to devote to each student. Inattentive type is also more likely to be missed in girls, for multiple reasons (I'd need to dig out the cites from back in grad school). Some folks are skeptical of adults seeking a first-time evaluation for ADHD, seemingly because they believe that 'legit' ADHD would have come to clinical attention earlier in life.
I may be an N of 1, but I will throw myself out there as an example: I wasn't diagnosed until I was a successful adult in a respected PhD program. In retrospect, it took a great deal of effort to compensate for my deficits throughout childhood, adolescence, and early adulthood, but I was able to make it work. Looking back at old report cards and progress reports, there are clear examples of inattentive symptoms, but I was a smart, well-behaved child who attended large public schools and didn't cause trouble. I wish that the issue could have been identified earlier somehow, because I wasted a lot of time thinking that I was less capable than my peers and feeling stupid for having work harder at basic stuff. But sometimes that's just how things go - the teachers were doing their best to manage their classrooms full of kids, and that needs to take priority over wondering whether an individual child may need a learning assessment.
Short and sweet, since it's come up a few times in this thread - the fact that I wasn't assessed as a kid doesn't mean that I was a malingering adult. And in any case, stimulant medication is helpful (especially for people who need it) but it won't magically give you knowledge or abilities. If you haven't learned the material, popping a stimulant alone is not going to get you an A on the exam.
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