The ADHD Label and Mortality

On February 26, 2015, The Lancet published online an article by Soren Dalsgaard et al titled Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study.

The article describes a Danish study that was designed to assess “ADHD-related mortality in a large cohort of Danish individuals.”

The researchers describe their methods as follows:

“By use of the Danish national registers, we followed up 1·92 million individuals, including 32 061 with ADHD, from their first birthday through to 2013. We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, family history of psychiatric disorders, maternal and paternal age, and parental educational and employment status, by Poisson regression, to compare individuals with and without ADHD.”

Data for the study was obtained from The Danish Civil Registration system, The Danish Psychiatric Central Register, and the Danish National Patient Register.

Here’s the authors’ summary of their findings:

“During follow-up (24·9 million person-years), 5580 cohort members died. The mortality rate per 10 000 person-years was 5·85 among individuals with ADHD compared with 2·21 in those without (corresponding to a fully adjusted MRR of 2·07, 95% CI 1·70–2·50; p<0·0001). Accidents were the most common cause of death. Compared with individuals without ADHD, the fully adjusted MRR for individuals diagnosed with ADHD at ages younger than 6 years was 1·86 (95% CI 0·93–3·27), and it was 1·58 (1·21–2·03) for those aged 6–17 years, and 4·25 (3·05–5·78) for those aged 18 years or older. After exclusion of individuals with oppositional defiant disorder, conduct disorder, and substance use disorder, ADHD remained associated with increased mortality (fully adjusted MRR 1·50, 1·11–1·98), and was higher in girls and women (2·85, 1·56–4·71) than in boys and men (1·27, 0·89–1·76).” [Emphasis added]

So, essentially, the authors identified a cohort of almost 2 million people, 32,061 of whom had been assigned a “diagnosis of ADHD”.  During the follow-up period the death rate per 10,000 person-years was 5.85 in the ADHD group vs. 2.21 for the remainder.  These figures yield an adjusted risk ratio of 2.07.  In other words, the individuals who had been labeled ADHD had approximately double the mortality risk as those who had not been so labeled.

But many of the individuals who had been labeled ADHD had also been assigned the labels “oppositional defiant disorder”, “conduct disorder”, and “substance abuse disorder”.  These additional labels were also associated with increased mortality.  When the excess mortality associated with these additional labels was adjusted out, the ADHD individuals were found to have a 1.50 mortality risk ratio compared with individuals in the cohort who had acquired none of the psychiatric labels mentioned.

DISCUSSION

The central problem in research of this kind is in the general concepts rather than the specific details.  In their final paragraph, the authors state that:

“ADHD is a common neurodevelopmental disorder known to cause impairment across the lifespan”

and indeed the entire article is written from a medical perspective, as if ADHD were a bona fide illness like pneumonia or kidney failure.

Note the perfect example of psychiatric “logic” in the above quote:  ADHD causes impairment.  So if a parent were to ask the authors why her child is so distractible, impulsive, and hyperactive, she will receive the reply:  because he has ADHD; ADHD causes the distractibility, impulsivity, and hyperactivity.  But if she presses the issue and asks how the psychiatrist knows that the child has ADHD, the only possible answer is because he is so distractible, impulsive, and hyperactive.  The only evidence for the so-called disorder is the very behavior that it purports to explain.  Labeling a child ADHD explains nothing.  Its only purpose is the legitimatization of drugs.

ADHD is nothing more than the loose cluster of vaguely defined behaviors listed in the DSM and the ICD.  The APA describes these behaviors as “symptoms”, but this is a misnomer.  In real medicine the illness does indeed cause the symptoms, and provides an explanation for the symptoms.  Pneumonia, an infection of the lung, causes coughing, exhaustion, and nasty-looking phlegm.

But in ADHD, as in all so-called psychiatric illnesses, this is not the case.  In psychiatry, the “symptoms” are the “illness”.  There is no causative disease entity behind the “symptoms” as there is in real medicine.  In psychiatry, the so-called symptom list, with all its vagueness and polythetic variability is the illness.  And in particular, despite psychiatry’s routine claims to the contrary, there is no neurological pathology common to all, or even most, of the individuals who acquire this label.

The fact that the authors refer to ADHD as a neurodevelopmental disorder probably reflects the fact that in DSM-5, this “diagnosis” is in the section headed “Neurodevelopmental Disorders”.  But this is very misleading.  Most people on hearing that ADHD is a neurodevelopmental disorder would assume that a neurological pathology is implied.  This is emphatically not the case.  The chapter on Neurodevelopmental Disorders in DSM-5 begins:

“The neurodevelopmental disorders are a group of conditions with onset in the developmental period.  The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.  The range of developmental deficits varies from very specific limitations of learning or control of executive functions to global impairments of social skills or intelligence.”

As the reader can see, there is no requirement of proven, or even suspected, neurological pathology.  All that’s required is that the individual be functioning below par (for any reason) in one or other of these areas.  The use of the term “neurodevelopmental disorders” is deceptive, and is another example of psychiatric assertion as a substitute for truth.

In the present study, the ICD lists were used to identify the ADHD group.  Here are some of the items on this list that might have a bearing on accident-related mortality.

  • unduly high distractibility…
  • undue lack of persistence at tasks…
  • very often runs about or climbs excessively in situations where it is inappropriate…
  • often has difficulty waiting turns…
  • excessive motor restlessness…
  • excessive levels of off-task activity…

It doesn’t take a great deal of imagination to see how children and adults whose habits and behaviors attract these kinds of descriptions might have a higher accident-related mortality than individuals who do not function in these ways.

“Unduly high distractibility”, for instance, is an obvious causal factor in motor vehicle accidents.  People who are distractible – i.e. who have not acquired the habit of screening out extraneous stimuli – will, other things being equal, have a higher accidental death rate than people who do screen out extraneous stimuli.

Similarly, “often has difficulty waiting turns”.  A great many traffic accidents are caused by people who become impatient in a line of traffic, and pull out to pass when it is not safe to do so.  And “excessive levels of off-task activity” would certainly include texting while driving – a known killer.

By defining ADHD by the presence of these behaviors, psychiatrists have, in effect, guaranteed that the group of people identified will have excess accident-related mortality.

In effect, all that Soren Dalsgaard et al have established is that people who engage in impulsive, high-risk behavior have a higher mortality rate than people who don’t.  That’s all there is to it.  The injection of ADHD, the “common neurodevelopmental disorder” adds nothing to the understanding of the matter, and in fact, serves to distract from the critical issue:  that we need to train children to pay attention, and not to be impulsive in matters that involve safety.

AND INCIDENTALLY

Under the heading Acknowledgements, the article states:

“This study was supported by a grant from the Lundbeck Foundation.”

Four of the five authors, Drs. Dalsgaard, Østergaard, Mortensen, and Pedersen, are affiliated with the Lundbeck Foundation Initiative for Integrative Psychiatric Research.

And, predictably, the study generated a good deal of media attention.  Here are some media quotes:

Risk for Dying Young Increased With ADHD Diagnosis, Study Finds Psychiatry News:

“The results, published in Lancet, showed that of the 32,061 individuals with a diagnosis for ADHD, 107 died before the age of 33—a rate that is twice that for persons without the disorder, even after adjusting for factors that increase risk for premature death such as history of psychiatric disorders and employment status.”

A.D.H.D. Diagnosis Linked to Increased Risk of Dying Young The New York Times:

“People with a diagnosis of attention deficit disorder are at higher risk of dying young than those without the disorder, usually in automobile crashes and other accidents, suggests research reported on Wednesday, from the largest study of A.D.H.D. and mortality to date.”

“The risk was even higher in people who received a diagnosis at age 18 or later, the study found — possibly because of the severity of such cases, the authors wrote.”

A new study shows there’s a strong link between ADHD and premature death Vox Topics:

“When the researchers followed the group for the next three decades to learn about how they fared, they came to some startling conclusions. Compared to people without ADHD, those who had the disorder were twice as likely to die prematurely — and much more accident prone.” [Emphasis added]

People who are distractible and impulsive have a higher death rate from accidents.  That’s a startling conclusion!

ADHD linked to greater risk of dying young Science Nordic:

“People with ADHD face a risk of premature death 1.5 to 8 times greater than those without the disorder. That’s the conclusion of a new study involving 32,000 Danes with ADHD and more than a million Danes without the disorder.”

Study Finds People with ADHD More Likely to Die Prematurely Psychology Today:

“ADHD is more than just a learning disability or mental health condition. It does far more than just inhibit learning or make children more ‘difficult.’ According to one new study, it greatly increases its sufferers’ odds of dying young.”

ADHD Greatly Increases Risk of Premature Death Psychiatric Advisor:

“In an associated comment to the study, Stephen Faraone, PhD, Director of Child and Adolescent Psychiatry Research at SUNY Upstate Medical University in New York, wrote, ‘For too long, the validity of ADHD as a medical disorder has been challenged. Policy makers should take heed of these data and allocate a fair share of health care and research resources to people with ADHD. For clinicians, early identification and treatment should become the rule rather than the exception.'”

Note the very nice example of psychiatric logic:  because individuals who are distractible and impulsive have a higher mortality rate, then their label – ADHD – must be valid!  People who ride motorcycles routinely also have a higher than average accident-related mortality rate.  Should we therefore conclude that riding motorcycles is a “valid” illness?

AND ON A PERSONAL NOTE

Recently my wife and I were taking our grandsons home   My wife was driving.  Our 6-year-old grandson was asking her lots of questions.  After a while I suggested that he ease up on the talk, and let his grandmother concentrate on driving.  He agreed readily.  “Otherwise,” he added, “we could have an accident, and we’d all be killed.”

Such startling wisdom – out of the mouths of babes.  As I’ve said many times, critiquing psychiatry is not quantum physics.

  • Sweet63

    About 20 years ago I saw a psychologist, an old-school guy close to retirement. He said in passing that there was no ADHD in Europe, that it was strictly an American phenom. Of course he was quite suspicious of the whole thing. I take it the Euros are up to their eyeballs in Ritalin now? Was it just a lag in marketing?

  • Harry hobbes

    Absolutely. We are targeting Japan, China and Africa next. Get in while the gettings good, babe. There are so many more people we hope to hook and destroy. The money is unreal.

  • Phil_Hickey

    Sweet63,

    Yes, I think so. Europeans used to be a bit more skeptical, but they’re buying the drugs like the proverbial hot cakes now.

    Best wishes.

  • “Its only purpose is the legitimatization of drugs.” Really? I find your perspective on ADHD appalling, especially being that your a mental health professional.

    If ADHD isn’t a “real disorder,” then how do you explain the negative life-impact of the cluster of these traits? And what about the additional executive functioning deficits, social issues, etc., and their impact?

    Do people and corporations make money off the treatment of ADHD? Yep, no doubt. But people and corporations make money off the treatment of diabetes, cancer, depression, anxiety, heart disease, etc. Why aren’t those individuals vilified as well?

    All you are doing is making life harder for kids and adults with legitimate ADHD.

    Penny Williams
    Author of “What to Expect When You’re Not Expecting ADHD” and “Boy Without Instructions: Surviving the Learning Curve of Parenting a Child with ADHD”
    ParentingADHDChildren.com

  • Lm1503

    It’s easy to see how an individual meeting adhd criteria I.e presenting with the aforementioned traits might experience ‘negative life impacts’. The crux of the issue however is the etiology of such traits. Are they understandable responses to environmental factors or are they due to a ‘disordered’ brain. For some reason, many people subscribe to the notion that for a problem of living to have legitimacy it must have a label AND a biological explanation, environmental accounts apparently will not do. We are each unique, complicated individuals who from the moment of birth have been shaped by an uncomprehenable amount of stimuli. Why pain ourselves by saying we are disordered or mentally Ill especially as there are better, more intellectually rigorous ways of understanding why we do what we do.

  • all too easy

    “For some reason, many people subscribe to the notion that for a problem of living to have legitimacy it must have a label AND a biological explanation”
    Couldn’t care less about a label. Many couldn’t care less. Premise is irrelevant; it has nothing to do with ADHD. Many don’t care about what explains it. You do. Phil and Breggin and Baughman and Witty do. We just want to treat it. Reduce the hellish symptoms any way that works. Call it AZ-23+6yt from Pluto. Who cares? Make the debilitating inattention, impulsivity and disorganization go away! And please, try to sound more condescending as you talk down to millions of damaged folks, please. It is so sweet of you.

  • Phil_Hickey

    Penny,

    Thanks for coming in.

    Cite me one piece of evidence – just one – that the various problems which are embraced by the term ADHD are in fact caused by a neurological illness. That’s the only issue. Send me the reference, and I’d be happy to take a look.

    Best wishes

  • Harry hobbes

    Name one proven cause of ADHD that isn’t neurological.

  • Harry hobbes

    Name one proven example in which the ability to think resides outside the brain.

  • Harry hobbes

    Phil says the meds used to treat ADHD merely make children behave. Gosh, Phil, do you really mean to say that meds can influence the central nervous system? They can do no such thing according to you. Chemicals can not influence cognition. Because, if they could, it must follow that the lack of or the failure of the human brain to utilize certain physical/electrical/chemical processes would cripple the brain. That cannot happen, right Big Guy? The brain has a mind of its own, not dependent upon the real world of atoms and flesh and blood and oxygen.

    Phil, do me a favor. Remove the measurable, odorless gas called oxygen from your neurons and tell us how your brain is getting along. Ready? Begin.

  • all too easy

    “The widespread acceptance of ADHD as a mental illness/chemical imbalance has no scientific underpinning, but rather is based on marketing and promotion.”
    There IS NOT ONE SINGLE SOLITARY IOTA of proof that your comment is factual.

    Take your time and summarize what the following information reveals about mental illness. I realize no one will.

    BACKGROUND: This study utilized diffusion tensor imaging (DTI) to analyze white matter tractography in the anterior limb of the internal capsule (ALIC), fornix, and uncinate fasciculus (UF) of individuals with 22q11.2 deletion syndrome and controls. Aberrations in these tracts have been previously associated with schizophrenia. With up to 25% of individuals with 22q11.2DS developing schizophrenia in adulthood, we hypothesized reduction in structural integrity of these tracts, including an association with prodromal symptoms of psychosis. We further predicted an association between allelic variation in a functional polymorphism of the Nogo-66 receptor gene and 22q11.2DS white matter integrity. METHODS: Tractography was conducted using fiber assignment by streamline tracking algorithm in DTI Studio. Subjects were genotyped for the rs701428 SNP of the Nogo-66 receptor gene, and assessed for presence of prodromal symptoms. RESULTS: We found significant group differences between 22q11.2DS and controls in DTI metrics for all three tracts. DTI metrics of ALIC and UF were associated with prodromal symptoms in 22q11.2DS. Further, ALIC DTI metrics were associated with allelic variation of the rs701428 SNP of the Nogo-66 receptor gene in 22q11.2DS. CONCLUSIONS: Alterations in DTI metrics suggest white matter microstructural anomalies of the ALIC, fornix, and UF in 22q11.2DS. Structural differences in ALIC appear to be associated with the Nogo-66 receptor gene, which has been linked to myelin-mediated axonal growth inhibition. Moreover, the association between psychosis symptoms and ALIC and UF metrics suggests that the Nogo-66 receptor gene may represent a susceptibility gene for psychosis through its disruption of white matter microstructure and myelin-associated axonal growth.

    1Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, USA.
    2Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.Publisher:Elsevier SciencePublication Date: Jan-2014

    Cereb Cortex. 2015 May;25(5):1143-51. doi: 10.1093/cercor/bht308. Epub 2013 Nov 11.

    Cognitive Ability is Associated with Altered Medial Frontal Cortical Circuits in the LgDel Mouse Model of 22q11.2DS.

    Meechan DW1, Rutz HL2, Fralish MS1, Maynard TM1, Rothblat LA2, LaMantia AS1.

    Author information

    1Department of Pharmacology and Physiology GW Institute for Neuroscience, The George Washington University, Washington, DC 20037, USA.

    2Department of Psychology GW Institute for Neuroscience, The George Washington University, Washington, DC 20037, USA.

    We established a relationship between cognitive deficits and cortical circuits in the LgDel model of 22q11 Deletion Syndrome (22q11DS)-a genetic syndrome with one of the most significant risks for schizophrenia and autism. In the LgDel mouse, optimal acquisition, execution, and reversal of a visually guided discrimination task, comparable to executive function tasks in primates including humans, are compromised; however, there is significant individual variation in degree of impairment. The task relies critically on the integrity of circuits in medial anterior frontal cortical regions. Accordingly, we analyzed neuronal changes that reflect previously defined 22q11DS-related alterations of cortical development in the medial anterior frontal cortex of the behaviorally characterized LgDel mice. Interneuron placement, synapse distribution, and projection neuron frequency are altered in this region. The magnitude of one of these changes, layer 2/3 projection neuron frequency, is a robust predictor of behavioral performance: it is substantially and selectively lower in animals with the most significant behavioral deficits. These results parallel correlations of volume reduction and altered connectivity in comparable cortical regions with diminished executive function in 22q11DS patients. Apparently, 22q11 deletion alters behaviorally relevant circuits in a distinct cortical region that are essential for cognitive function.

    Please, make sure to ignore the most recent research on the physiology of mental disorders. No one wants to be associated with anything that blows away all the “facts” the antis have amassed.

    CONCLUSIONS: Alteration in the neural basis of two cognitive control operations in childhood ADHD was characterized by distinct, rather than unitary, patterns of functional abnormality. Greater between-group overlap in the neural network activated for interference suppression than in response inhibition suggests that components of cognitive control are differentially sensitive to ADHD. The ADHD children’s inability to activate the caudate nucleus constitutes a core abnormality in ADHD. Observed functional abnormalities did not result from prolonged stimulant exposure, since most children were medication naïve.

    Altered Neural Substrates of Cognitive Control in Childhood ADHD: Evidence From Functional Magnetic Resonance Imaging

    Chandan J. Vaidya, , Ph.D.

    Chandan J. Vaidya

    Search for articles by this author

    Silvia A. Bunge, , Ph.D.

    Silvia A. Bunge

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    Nicole M. Dudukovic, , B.A.

    Nicole M. Dudukovic

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    Christine A. Zalecki, , M.A.

    Christine A. Zalecki

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    Glen R. Elliott, , M.D., Ph.D.

    Glen R. Elliott

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    John D.E. Gabrieli, , Ph.D.

    John D.E. Gabrieli

    In children with attention deficit hyperactivity disorder (ADHD), functional neuroimaging studies have revealed abnormalities in various brain regions, including prefrontal-striatal circuit, cerebellum, and brainstem. In the current study, we used a new marker of functional magnetic resonance imaging (fMRI), amplitude of low-frequency (0.01–0.08 Hz) fluctuation (ALFF) to investigate the baseline brain function of this disorder. Thirteen boys with ADHD (13.0 ± 1.4 years) were examined by resting-state fMRI and compared with age-matched controls. As a result, we found that patients with ADHD had decreased ALFF in the right inferior frontal cortex, left sensorimotor cortex, and bilateral cerebellum and the vermis as well as increased ALFF in the right anterior cingulated cortex, left sensorimotor cortex, and bilateral brainstem. This resting-state fMRI study suggests that the changed spontaneous neuronal activity of these regions may be implicated in the underlying pathophysiology in children with ADHD.

    Moving beyond models of ADHD focused on a limited set of brain regions, the maturing fMRI literature in ADHD reveals dysfunctions in regions belonging to multiple neuronal networks involved in higher-level cognitive and sensorimotor functions. Our results were not ascribable to stimulant treatment history or presence of comorbidities. The systems neuroscience perspective we adopted is in line with the NIH Research Domain Criteria framework (48), which conceptualizes mental disorders in terms of dysfunctions of brain circuits to inform future nosological systems beyond a symptoms-based approach. Future work aimed at understanding the interplay among large-scale neural networks and their links to ADHD symptom dimensions should illuminate the pathophysiology of this common and vexing disorder.

    Author and Article Information

    From the Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York; the Child Neuropsychiatry Unit, G. B. Rossi Hospital, Department of Life Science and Reproduction, Verona University, Verona, Italy; UMR-S INSERM U 930, François-Rabelais University, Child Psychiatry Center, University Hospital, Tours, France; Neuroingenia, Mexico City, Mexico; the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y.; and the Center for the Developing Brain, Child Mind Institute, New York.

    Address correspondence to Dr. Castellanos (francisco.castellanos@nyumc.org).

    Dr. Cortese is supported by the Marie Curie grant for Career Development (Outgoing International Fellowship, POIF-253103) from the European Commission. This research was also supported by NIH grants MH083246, MH081218, HD065282, and K23M087770

    Dr. Phil, would you care to explain to your fans the specific, detailed, conclusions you draw from these studies in lay terms? Or, I’ll tell them. ADHD ain’t misbehaving uall!

  • Harry hobbes

    Thanks for preaching nonsense, Phil. Or, perhaps you are right. Maybe I am just an undisciplined boob who wants to abuse the drugs that are prescribed to assuage the symptoms of a made-up disorder. As an adult, I guess I still suffer the consequences of being a spoiled brat who never learned patience and my parents never encouraged me to pay attention. That is your fact-based conclusion, right old boy? Except, you still won’t share your scientific resources for believing such terrific and non-spurious ideas. Shucks!

  • all too easy

    Most people I know enjoy getting in car accidents. They cherish their inattentiveness and impulsivity that leads to all kinds of horrible traffic deaths and injuries. They think its funny when they are arrested and jailed. They love to be laughed at and they long to be humiliated in public. You should try it sometime, Phil and friends. It is a hoot.
    Once again, Phil has gloriously nailed it on the head. All these problems are a function of misbehavior, especially the adults who should know better. They like being naughty. What can I say?
    And of course ADHDers don’t or at least shouldn’t mention the traits they have. Someone could inadvertently take what millions of them say and confirmed by their friends, family, teachers, employers and doctors, lump that information together and call it something for which there is no proof. We all know you can never trust what millions of folks from diverse backgrounds, and largely unknown to each other, with no known ulterior motive, say. They are obviously all co-conspirators in a plot to abuse themselves and the kids they hate with dirty rotten addictive speed. Most parents aspire to destroy their flesh and blood. Phil knows. How does he know? He hasn’t a single, sliver of evidence, but he knows it is because mom and dad didn’t discipline us. (This fella knows science!)
    Of course there is no proof. Why would drug cartels (a.k.a. Big Pharma) permit any research that might offer evidence that ADHD is a real disorder? They wouldn’t, obviously, and they control everything with all their money. It only makes sense.
    As you can see in the following data (which Phil will not touch), nothing in science demonstrates any significant differences in the ADHD brain compared to your average run of the mill grey mattered little organ. It should be simple. The brain is a very simple, basic, straight forward organ. It is no more wonderful or astonishing than a one celled amoeba. It thinks. It feels. It computes and breathes and hungers and talks and loves and hates and sends rockets to the moon and probes beyond Pluto. That all. A bird can think. Cleodopluss, even our boy clepatrupuss, thinks occasionally. So, there is really nothing more to consider.
    I do wish Phil would ask his medical doctor friends to address all the silliness I’ve posted over the last few days. It should be easy for them to dismiss all this nonsense that proves ADHD is all in one’s mind.
    Joel Nigg (2015). ADHD: New Approaches to Subtyping and Nosology. The ADHD Report: Vol. 23, No. 2, pp. 6-9,12.

    doi: 10.1521/adhd.2015.23.2.6

    ADHD: New Approaches to Subtyping and Nosology

    Joel Nigg, Ph.D.
    Professor of Psychiatry and Director of the Division of Psychology at the Oregon Health & Science University in Portland.

    This work was supported by NIMH grant #R37-59105.

    He can be contacted at Psychology Division, Department of Psychiatry, Oregon Health Sciences Center, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098. E-mail: niggj@ohsu.edu.

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    Background:  Brain activation differences between 12 control and 12 attention deficit hyperactivity disorder (ADHD) children (9- to 12-year-olds) were examined on two cognitive tasks during functional magnetic resonance imaging (fMRI).

    Method:  Visual selective attention was measured with the visual search of a conjunction target (red triangle) in a field of distracters and response inhibition was measured with a go/no-go task.

    Results:  There were limited group differences in the selective attention task, with control children showing significantly greater intensity of activation in a small area of the superior parietal lobule region of interest. There were large group differences in the response inhibition task, with control children showing significantly greater intensity of activation in fronto-striatal regions of interest including the inferior, middle, superior and medial frontal gyri as well as the caudate nucleus and globus pallidus.

    Conclusion:  The widespread hypoactivity for the ADHD children on the go/no-go task is consistent with the hypothesis that response inhibition is a specific deficit in attention deficit hyperactivity disorder.

  • Lm1503

    it is my firm opinion that adhd traits can be born out of early life experiences. would you agree that it is possible for such traits to occur in a healthy brain exposed to certain life circumstances? i can see how such traits could arise out of ‘disorder’ e.g. brain injuries such as stroke, hypoxia etc. can you acknowledge both routes?

  • Lm1503

    totally agree, the only end game is reducing suffering, and the only reason for trying to understand etiology is to make peoples lives easier.

  • all too easy

    Dr. Joel Nigg Ph.D.

    Education

    Ph.D. University of California, 1996
    M.S.W. The University of Michigan, 1985
    A.B. Harvard Univeristy , 1996

    Forgot to mention Dr. Nigg’s educational qualifications. I doubt he has to sell speed to make a buck, you think, Phil? Whoops. Sorry, Phil, he must be a part of the multi-million man, woman and child conspiracy to conquer the world thru Big Pharma + Company. Oh the horror!

    Phil,

    Thanks for coming in.

    Cite me one piece of evidence – just one – that the various problems which are embraced by the term ADHD are in fact caused by poor parenting and a lack of discipline. That’s the only issue. Send me the reference, and I’d be happy to take a look.

    Best wishes,
    All Too Easy
    Beloved Lm, all we want is a label and a biological explanation. Then we can do drugs legitimately. Oh, and you are correct. We enjoy the pain we inflict on ourselves by pretending to have what doesn’t exist so we can get high. We don’t like scientific explanations like Phil does.
    Don’t condescend to me and others you don’t and will never understand. You haven’t a clue. Beat it

  • Rob Bishop

    Is diffusion tensor imaging ever used to diagnose people? One thing that consistently confuses me about my friends who say they have ADHD is they have an incredible ability to focus. Not science, but a trend I’ve noticed.

  • Rob Bishop

    Humans possess a wide range of mental functioning. Because an individual is on one end of the bell curve does not mean they are biologically defective.

  • all too easy

    “In children with attention deficit hyperactivity disorder functional neuroimaging studies have revealed abnormalities in various brain regions, including prefrontal-striatal circuit, cerebellum, and brainstem…”

  • Rob Bishop

    The seductive perspective, “I’m screwed up” is very common and attractive. Do you agree most people think something is wrong with themselves? There’s thousands of “scientific studies” that “prove” biological abnormalities associated with ADHD, depression, and anxiety. But where are the associated scientific tests for diagnosis? Everyone struggles with mental disturbances. To promote the fact our disturbances can be greatly reduced and even neutralized, without drugs, is empowering, not condescending. Many people find the disease theory of addiction/depression/ADHD etc. condescending and demeaning. It spreads the belief that people are powerless over their afflictions.

  • Harry hobbes

    Read up on the topic. People with ADHD can hyperfocus, too. When they find something that is fascinating or find themselves in novel situations, the ADHDer may zone in and block out everything not relevant unaware he is doing so. It is not because he wills himself to focus so intensely. Something is triggered in his brain that allows this to happen.

    You know very little about ADHD. You are convinced you know a great deal. You do not. Start listening.

  • Rob Bishop

    I have a child diagnosed with OCD, and I have strong obsessive tendencies. I’m intimately familiar with hyper-focusing.

  • Harry hobbes

    You are not confused then.

  • Rob Bishop

    Being confused is normal. Believing confusion is bad is self-inflicted suffering.

  • all too easy

    I agree with you Rob. In fact, I recognized it instantly. You cannot have an intelligent conversation with me, so don’t try. I’m too busy.

  • all too easy

    Who said people with ADHD were on the low end and defective? LOL

  • all too easy

    why lie? Why divert? Why say you have OCD? Why say you have kids with ADHD? Why disregard questions you don’t like? Why change the subject and make stupid comments?

  • ADDspeaker

    Being a clinical diagnosed person, with a valid and extensive personal experience of living with undiagnosed ADHD for 40 years and now as diagnosed and properly medicinal treated for it, as well as a self-educated “scholar” of scientifically evidence based literature on the ADHD subject, I believe I am able to comment on your conclusions, with some degree of confidence.

    1. ADHD is a neurodevelopment disorder which is caused by either neuro-genetic reasons in 70% af cases or caused by environmental and neuro-biological reasons in 30% of the cases of ADHD.

    2. It is classified as such, due to the extensive scientific research (more than 10,000 published studies), based on solid scientific facts, and is supported by WHO, UN, DSM, ICD.

    3. The physical component of ADHD results in an delay in the development of the physical brain structures in various areas, during the foetus stage and all the way until we reach age 30.

    4. ADHD is either a genetic transferred set of genes, during the conception or by environmental influence during pregnancy, such as lead poisoning, alcohol or substance abuse, smoking and more.

    5. ADHD gives a life-long , chronic and permanent mental impairment, not by simply having the diagnosis of ADHD, but due to the massive consequences the symptoms of ADHD causes, primarily in social and work related contexts. It is only in the public setting, where our impairment becomes apparent to others, that we are impaired, compared to people who do not have ADHD.

    6. The reason for our impaired behaviour is to be found in both the developmental delays in the brain, as well as in the 30% reduced cognitive capabilities that stems from the lack of communication in the neurotransmitters and in the Executive Functioning in 5 distinct areas, which causes our Emotional Self-Regulation and Motor Inhibition to collapse, so that the “Private Self” and the “Public Self” gets mixed up and causes our external behaviour, verbal and nonverbal.

    7. ADHD can be treated with Stimulants, which increase the production of certain neurotransmitters, like Dopamin, which in turn creates a linkage between the underdeveloped parts of the brain, which creates a time-limited connection, and helps us suppress our Emotional Self-Regulation and Executive Functioning impairment, and makes us able to use psychosocial behavioural modification training to correct our behaviour and alter our reactions, emotionally, internally and externally.

    8. Dalsgaard et al. have shown that by giving children the correct ADHD medication and in the correct dosage, it is possible to lower the risk of injuries (43%) and emergency room visits (45%), as opposed to those children with ADHD, who are not being treated medicinally for their ADHD.

    9. Dalsgaard et al. have shown that the risk of dying due to injuries, accidents and life style related issues (obesity, diabetes, cardiovascular) is 50% higher in the population with ADHD vs. those without ADHD.

    Conclusion:
    In my opinion, you are concluding on a misinformed set of facts, which are not in accordance with the vast majority of both the scientific, medical or even the people who themselves, suffer from ADHD. ADHD is real, it’s a mental disorder which causes serious impairment in all of the major domains of life, please show the necessary understanding, recognition and respect for this of us than were born into an illness, which we in no sense have contributed too.

    Thank you,
    /Peter

    If you wish to broaden your understanding and factual knowledge on the subject of ADHD, may I suggest that you visit my blog?

  • ADDspeaker

    ADHD do not cause hyper focusing. Hyper focusing is a trait of Autism, not ADHD. ADHD can cause perseverance, which is the root cause for our kind of “hyperfocus”. It is not like we get stuck on a topic or behaviour, but that we are unable to sustain from discontinuing a behaviour, although we intellectually do understand, that it is not in our long-term self interest to continue with this behaviour. It is rooted in our developmental delay in our Executive Functioning, not in the same area as is known to cause Autisme hyper focusing.

    Source:
    “Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. E. (2005). Executive functioning in hyperactive children as young adults: Attention, inhibition, response perseveration, and the impact of comorbidity. Developmental Neuropsychology, 27, 107–133.”

    Excerpt From: Russell A. Barkley. “Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment.” iBooks.

  • ADDspeaker

    Again, this is not the same as autistic hyper focusing, it is the your Inhibition control part of your Executive Functioning, that in combination with your OCD, keeps you and others with similar disorders, locked into a repetitive behaviour. It is a cognotive failure, not a motor failure, as is the case with Autism.

  • ADDspeaker

    +1

  • ADDspeaker

    OK, so not being able to suppress the “internal dialogue” and not express your “Private Self”, externally as verbally and nonverbally behaviours, is not consider a mental disorder, correct? I wasn’t raised into being symptomatic of ADHD, I was born into having the symptoms, because of my ADHD. You cannot get ADHD from “bad parenting”, it has been proven in over 40 separate twin studies, so please accept that the “traits” of ADHD is not by choice or liberty, but by a mental disorder, a lack of maturation in the brain, not in lack of psychosocial nurturing.

  • anonymous

    Nothing “factual” there http://addspeaker.net/

  • ADDspeaker
  • lm1503

    Not being able to express ‘private self’ is not a listed symptom of ‘adhd’ to my knowledge. Are you suggesting that environmental factors cannot possibly influence attentiveness and impulsivity? Would you concede that in some cases it is possible to develop difficulties regulating behaviour and attention and meet the checklist for an adhd diagnosis due to early life experiences? If so, how can you determine, then, when traits associated with the label adhd are due to a brain dysfunction and when are learned cognitive and behavioural patterns that evolved out of a healthy, non-disordered brain responding to the world it has had to negotiate from inception? The fact that you cannot tell, and psychiatry would admit it cannot tell, says something about adhd. It is not a unified ‘thing’ or disorder that can be located. It is a collection of cognitive functions and behaviours to which people exist on a spectrum of as opposed to an adhd/non adhd dichotomous organic entity. IMO.

  • ADDspeaker

    “Not being able to express ‘private self’ is not a listed symptom of ‘adhd’ to my knowledge”.
    I guess I must have.expressed myself poorly, so let me rephrase: I am not saying that people with ADHD are not able to express their ‘private self’, but that we are impaired in the Executive Function that manages our inhibition of keeping our ‘internal dialogue’ from being executed in motor functioning, and thus not kept to our ‘private self’ in our mind, but instead become externally expressed both verbally and non verbally.

    As regards to your other questions, let me refer you to the 4th edition of the ADHD Handbook for Diagnosis & Treatment (2015), which explains the newest scientific findings on what ADHD is known to be today.

    “In essence, this EF operated in conjunction with that of behavioral inhibition chiefly to accomplish four purposes very similar to the components of the earlier definition of emotional regulation by Gottman and Katz (1989).”

    “First, the inhibitory function served to delay (inhibit) the initial prepotent or dominant responses to an event, including their emotional tone and other emotional behavior, so that both the motor response and related emotional behavior were deferred. This set the stage for the second purpose of this EF, which was the modification of the initial emotional state to make it more congruent with and supportive of the individual’s long-term goals. In part, this involved the use of the working memory systems (self-directed visual imagery and self-speech) to assist with self-soothing of emotional arousal and to create hindsight. The latter allowed the individual to consider consciously what had previously been experienced in similar situations and so guide the construction of the eventual response to the event informed by such prior information”

  • anonymous

    Ooooooh. The endorsement by Isaac Newton is a nice touch. Very “sciencey,” indeed. Do you have any idea how hilarious this is? “Scientifically Proven Knowledge on ADHD” Haaaaa ha ha ha ha ha ha ha ha ha ha ha ha

  • Lm1503

    If someone has poor attention compared to their peers, is more distractible, is very talkative, finds it difficult to remain still, is boisterous, tends not to plan much, can rush into things…if someone displays all these behaviours then there is every chance that if they see a psychiatrist that they will be given a diagnosis of adhd. There is nothing more to it. No scans, nothing scientific. The psychiatrist will simply tick off behaviours and if an arbitrary amount of them match the criteria cut-off then, bang, they now have a disorder of the brain called adhd. How confident do you then feel that everyone with a diagnosis of adhd can be grouped together? What confidence does that Instill in you about the notion of a ‘brain disorder’? Does doubt creep in that what one is dealing with the term ‘adhd’ might be instead merely a label to capture a myriad of different presentations which can be generated for fundamental different reasons from person to person and which psychosocial factors (such as abuse, family dynamics, early attachment with primary caregivers, early neglect) and social & cultural norms about what constitutes appropriate and inappropriate conduct, especially in schools, could be significant? I’d be cautious about being so confident that you understand what is going on for every individual who leaves a psychiatrist’s office with a label of adhd. One persons inattention could be due to adverse experiences such as trauma, another could be due to growing up in a poor, noisy large household where education was not valued, another could be due to having a depressed mother who could not meet the child’s emotional needs. You can see how utterly different these individuals would be and yet because they share some common traits that’s valid enough to box them all as having the same underlying condition? On a different note how do you reconcile the fact that many people given an adhd diagnosis do not have difficulties in verbal disinhibition but match the other ‘symptoms’? Does that not indicate that again the label is simply a collection of various traits and that it cannot be a specific condition? And as for trying to identify ‘adhd’ and saying things like sufferers have impaired executive functioning, well of course they do…executive functioning is itself a ‘term’ that encompasses different cognitive functions such as disinhibition, poor emotional regulation, poor planning and organising, poor impulse control…it’s just a rewording of the very traits on the adhd diagnostic checklist!

  • ADDspeaker

    I am glad that I can amuse you 🙂 Could you be a bit more specific in your critique? All the data and information I relay, is scientifically validated and I put references on my sources.

  • ADDspeaker

    Actually, all my articles are based on science or from the ADHD Handbook – Diagnosis and Treatment, 4th Edition, 2015, Edited by Dr. Russell A. Barkley and 51 other scientists who have participated in updating this 900 page extensive work of summation of 40+ years of his own research and more than 6,000 studies on ADHD from the past 10 years. So I can ensure you, that it is quite factual, whether you agree with me or not.

    If you could explain your own understanding of ADHD, I am more than willing to listen, I am very open to new information and I work with research on subjects on or related to ADHD, which I publish on my blog or in my book, which I am currently writing, with help from many of the top researchers on ADHD, world wide, Like Dr. Barkley, Søren Dalsgaard, Gina Pera and many others.

  • anonymous

    No, I couldn’t. There’s nothing there to critique – just some fawning comments about a “Dr. Barkley.” Maybe you directed me to the wrong site.

  • anonymous

    Gina Pera! LOL

  • ADDspeaker

    Sorry anonymous, English is not my first language, so I didn’t know the meaning of the word “fawning”, so I looked it up:

    “Fawn
    intr.v. fawned, fawn·ing, fawns

    1. To exhibit affection or attempt to please, as a dog does by wagging its tail, whining, or cringing.

    2. To seek favor or attention by flattery and obsequious behavior.”

    It surprises me, that you would describe my interest in and collaboration with, the most significant researcher, clinician and public communicator in research on ADHD, in the past 40+ years, as being an “attempt to please, as a dog does by wagging its tail”.

    If you would be truly willing to part from your limiting beliefs, and actually try to expand your knowledge, you would notice that Dr. Barkley is very keen on bringing “the totality of what we know in science” on the subject of ADHD, from every valid scientific source.

    Personally, Dr. Barkley have been nothing but forthcoming and extremely helpful, in my research for my book, and have even helped me get other contacts in the research area, so that I could get other views, than that of his own.

    So trust me when I say, that Yes I do respect Dr. Barkley immensely, both as a person and as an professional, for his vast contribution in the effort to “decode” the mental illness I have been born with, and have helped me and millions of others, to better cope with their daily life.

    If that comes across as “fawning” to you, that is on your perception, not mine or my 30,000 readers on my blog.

    Play nice, be respectful and don’t think that I am “under the influence” of anything else or anyone else, than my own firm belief in helping all others with ADHD, with knowledge and support, for that reason and that reason alone.

  • ADDspeaker

    You obviously do not know her and her contribution in the Adult ADHD community, and trust me, you do not get to write a full chapter in the ADHD Handbook, without your credentials being approved by the 50 or so other co-authors, who have a professional reputation in research, to uphold.

  • anonymous

    The term “ADHD Science” is an oxymoron.

  • anonymous

    Uh huh. And similarly, only the most respected witch hunters got to author the Malleus Maleficarum.

  • anonymous
  • Rob Bishop

    What scientific methods are used to identify and measure “cognitive failure”?

  • ADDspeaker

    Self-Regulatory Problems Are Commonly Associated with ADHD
    It is clear that some individuals have self-regulation problems that extend beyond the focus, restlessness and impulsivity challenges highlighted in the DSM core cri- teria of the disorder—although they may be considered as separate attributes, prob- lems with organizing personal schedule—such as sleep habits, eating habits or exercise habits, and problems controlling emotional expression are now thought to be common in, and etiologically very closely related to, ADHD in many individuals. A full evaluation of factors contributing to poor self-regulation of behavior extends beyond inventory of ADHD, to understanding the extent of self-regulatory chal- lenges in domains like daily patterns and control of internal states or expression of them, such as emotion control.

    I know that Dr. Barkley and his colleagues did develop a EF test focused on evaluation of the impairment in people with Adult ADHD, since test battery for EF normally being used, was not sufficiently specific to adhere symptoms in Adult ADHD. He talks about in this lecture if you wish to know more.

    http://youtu.be/hzhL-FA2v10

    “More to the point of this discussion, research has shown that rat“rating scales of DSM symptoms are so highly correlated with EF rating scales that they approach or meet standards of colinearity (synonymity) (Barkley, 2011b, 2012a). If that continues to be the case, then it may well be that the current conceptualization of the two DSM symptom lists for ADHD should be broadened to include metacognition or EF as representing the conceptualization of the inattention dimension and behavioral disinhibition or self-restraint as representing the hyperactive–impulsive dimension. At the very least, future DSM editions may need to broaden these conceptualizations in the associated text with the criteria even if the names for the symptom dimensions remain unchanged”

    “If that continues to be the case, then it may well be that the current conceptualization of the two DSM symptom lists for ADHD should be broadened to include metacognition or EF as representing the conceptualization of the inattention dimension and behavioral disinhibition or self-restraint as representing the hyperactive–impulsive dimension. At the very least, future DSM editions may need to broaden these conceptualizations in the associated text with the criteria even if the names for the symptom dimensions remain unchanged.”

    Excerpt From: Rusell A. Barkley. “Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment.” Guilford Publications, 2014-11-09T22:00:00+00:00. iBooks.
    This material may be protected by copyright.