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Does ADHD Really Exist?

Why is this a problem?

Sample Response to a Person with a General Lack of Knowledge of ADHD

Sample Response to a Person Who's Strongly Denying ADHD Exists

Clinical Evidence of The Existence of ADHD as a Real Condition

 

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Why is this a problem?


Occasionally I read about people who claim that ADHD doesn't exist. As if you cut down on sugar intake, turn off TV and computer games, and spin around 3 times and click your heels it will magically disappear.

Well, that is not true. For the people who have to deal with the challenges of ADHD, especially adults, who often have few resources available to them, this is like kicking someone when they're down.

Many people with ADHD don't seek a proper diagnosis of ADHD or learn the different ways to manage ADHD for themselves or their children because of the stigma created by some judgemental ignorant people.

Would you tell someone who's a diabetic that he shouldn't take insulin, it's not good for them, diabetes is a phoney condition thought up by the drug companies and all they have to do is stay away from the chocolate bars and have happy thoughts?

Why is it that people who would not assume they're knowledgeable enough to make pronouncements of the validity of physical medical conditions assume that they are knowledgeable enough to make sweeping pronouncements of the validity of mental medical conditions?

Why do they then decide (usually without doing any real research on the subject) that they know enough about what are acceptable and unacceptable treatments ( i.e., Ritalin as a tool of the devil theory) and condemn someone for using what they deem are unacceptable treatments? As if the brain is easier to understand than the body.

While ADD is sometimes underdiagnosed, overdiagnosed and misdiagnosed, most commonly UNDERdiagnosed, it is a real condition with often severe negative consequences for the person who has it.

Once they learn about the condition and begin to deal with it, by medication, coaching, therapy, support groups or other methods. Then they can start focusing on and developing the advantages of having ADHD.

Unfortunately, too many people with ADD don't even get diagnosed because of the misinformation and stigma out there by the ignorant (occasionally vocally ignorant). You can't deal with what you don't know you have.

So as an Adult ADHD Coach who has ADHD, and self medicates with information and learning, I've put together a few links to articles that give hard, clinical evidence of the existence of ADHD as a real condition.

If you have ADHD, how you decide to treat it should be your choice not something that is dictated by others. After all you're the one who has to deal with the consequences of your choices (or of simply continually researching the condition with little action).

Sample Response to a Person with a General Lack of Knowledge of ADHD


If someone simply has a lack of knowledge about ADHD, or believes the myths out there, you can give them this blood pressure analogy to explain it.

"We all have blood pressure. If it's in x range it's normal, if it's in y range it's a cause for concern, and if it's in z range you have a medical condition called hypertension and have to be treated for it."

You could use a similar example with blood sugar levels. I.e., occasionally low blood sugar, hypoglycemia and diabetes. You could also use the example of clinical depression. Some people have some of the symptoms of depression on occasion i.e., they may feel sad and depressed for a single day but that does not make them clinically depressed. You need to have a certain number of symptoms over a certain period of time and a certain degree of severity.

Most people have some of the symptoms of ADHD on occasion, but just becasues you're sad for a weekend, that doesn't make you clinically depressed. What makes it ADHD is:

  • How many of the symptoms you have
  • How severe the symptoms are
  • The degree that they negatively effect one or more areas of your life
  • How long they have been a problem in your life.

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Sample Response to a Person Who's Strongly Denying ADHD Exists

If that doesn't work and you're dealing with someone who is strongly denying that ADHD exists and claiming that ADHD is a not real condition, thereby stigmatizing those with ADHD and preventing other people who may have undiagnosed ADD from seeking treatment, you might consider asking them this question,

"What do you know about ADHD that the following institutions don't?

American Medical Association (AMA)
Canadian Medical Association
Canadian Psychological Association
Canadian Psychiatric Association
Surgeon General of the United States
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
American Academy of Pediatrics (AAP)
American Academy of Child and Adolescent Psychiatry (AACAP)
(See the bottom of this page for more details Real Science Defines AD/HD as Real Disorder).

They all say ADHD exists and is a real condition.

What research have you done that show's that all of the organizations above are wrong?"

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Clinical Evidence of the Existence of ADHD as a Real Condition.

 

International Consensus Statement on ADHD PDF

From Attitude Magazine. 75 international scientists were deeply concerned about the periodic inaccurate portrayal of ADHD in media reports. So they "created this consensus statement on ADHD as a reference on the status of the scientific findings concerning this disorder, its validity, and its adverse impact on the lives of those diagnosed with the disorder as of this writing (January 2002)"

Here's one particular quote I like

"To publish stories that ADHD is a fictitious disorder or merely a conflict between today's Huckleberry Finns and their caregivers is tantamount to declaring the earth flat, the laws of gravity debatable, and the periodic table in chemistry a fraud."

 

Two anterior regions of the corpus callosum were significantly smaller

in ADHD boys. MRI scans assessed the frontal circuitry in 18 ADHD boys in comparison to 18 matched controls. They found that two anterior regions of the corpus callosum (the rostrum and the rostral body) were significantly smaller and concluded that this was evidence for frontal lobe dysfunction and abnormal development. The callosal fibres in the rostral body relate to the premotor cortex, which is critical for “the suppression of relatively automatic responses to certain sensory stimuli”. This is consistent with a defect in the person’s ability to inhibit responses, which is considered by Barkley to be the fundamental deficit in ADHD.

 

Brain Imaging Data of ADHD. It's Not Just 3 Neurotransmitters

Psychiatric Times August 2004 Vol. XXI Issue 9. Amir Raz, Ph.D.

Neuroimaging assays have most consistently implicated abnormalities of the dorsal prefrontal cortex and basal ganglia in ADHD.

Reduced metabolic rates have been reported in the left sensorimotor area in children with ADHD and in the premotor and superior prefrontal cortices of adults with ADHD.

Positron emission tomography data from 10 adolescents with ADHD found reduced metabolic rates versus healthy controls in, among other regions, the left anterior frontal area, showing negative correlation with numerous symptom severity measure.

Smaller volumes of the right prefrontal cortex have been reported in children with ADHD compared with healthy controls.

Magnetic resonance imaging data demonstrated smaller right globus pallidus nuclei in boys with ADHD relative to a control group.

Individuals with ADHD had significantly smaller brain volumes in all regions, even after adjustment for significant covariates. This global difference was reflected in smaller total cerebral volumes and in significantly smaller cerebellar volumes.

Unmedicated children with ADHD also exhibited smaller total white matter volumes compared with controls and with medicated children with ADHD.

fMRI studies have reported abnormal activation of the striatum, prefrontal cortex and anterior cingulate cortex in ADHD.

Whereas control participants activated the anterior cingulate cortex, participants with ADHD seemed to rely on the anterior insula--a brain region typically associated with responses in more routine tasks not involving conflict.

 

Brain Scans Reveal Physiology of ADHD

Psychiatric News 2004. New high-resolution, three-dimensional maps of the brains of children with attention-deficit hyperactivity disorder indicate significant and specific anatomical differences within areas of the brain thought to control attentional and inhibitory control systems, compared with brain scans of children without ADHD.

The images are thought to be the most advanced to date to reveal the anatomical basis of the disorder. Includes two 3d scan photos.

 

Cerebral glucose metabolism in adults with ADHD

The New England Journal of Medicine. Researchers measured adults with ADHD with a PET scan. None of the adults had ever been treated with stimulant medication. RESULTS. Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls. The largest reductions were in the premotor cortex and the superior prefrontal cortex--areas earlier shown to be involved in the control of attention and motor activity. The largest reductions were in the premotor cortex and the superior prefrontal cortex--areas earlier shown to be involved in the control of attention and motor activity.

 

The dopamine theory of ADHD

Australian and New Zealand Journal of Psychiatry. The dopamine theory of ADHD is supported by neuroimaging, genetic and stimulant medication studies, which confirm an inhibitory dopaminergic effect at striatal/prefrontal level. Anterior and posterior attention systems are involved in inhibition, working memory and orientation. Attention deficit hyperactivity disorder symptoms and subtypes are likely to reflect deficits in both inhibition and working memory, and may be heterogenous.

 

PET, SPECT Studies Find More Evidence of Dopamine's Role in ADHD

From Medscape. Free registration required. Studies using positron emission tomography (PET) and other approaches suggest new details about the underlying biology of ADHD. Released here at the 50th annual meeting of the Society of Nuclear Medicine. 3 different studies mentioned.

 

Caudate nucleus volume asymmetry predicts ADHD symptomatology in children.

Journal of Child Neurology. 2002 Dec;17(12):877-84 Schrimsher GW, Billingsley RL, Jackson EF, Moore BD 3rd. Department of Psychology, University of Houston, Houston, TX, USA.

A greater degree of right to left caudate volume asymmetry predicted subclinical inattentive behaviors in a sample of nonreferred children. This finding is congruent with neuroanatomic models of attention emphasizing lateralized alteration in prefrontal/striatal systems. The results support the view that clinical ADHD is the extreme of a behavioral continuum that extends into the normal population.

 

ADHD is characterized by a delay in cortical maturation

Proceedings of The National Academy of Sciences of the USA
We found maturation to progress in a similar manner regionally in both children with and without ADHD, with primary sensory areas attaining peak cortical thickness before polymodal, high-order association areas. However, there was a marked delay in ADHD in attaining peak thickness throughout most of the cerebrum: the median age by which 50% of the cortical points attained peak thickness for this group was 10.5 years (SE 0.01), which was significantly later than the median age of 7.5 years (SE 0.02) for typically developing controls (log rank test χ(1)2 = 5,609, P < 1.0 × 10−20). The delay was most prominent in prefrontal regions important for control of cognitive processes including attention and motor planning. Neuroanatomic documentation of a delay in regional cortical maturation in ADHD has not been previously reported.
Supporting info and movies here

 

Cortical Thinning of the Attention and Executive Function Networks in Adults with ADHD

Cerebral Cortex 2007 17(6):1364-1375. ADHD has been associated with structural alterations in brain networks influencing cognitive and motor behaviors. Volumetric studies in children identify abnormalities in cortical, striatal, callosal, and cerebellar regions.

We carried out a structural magnetic resonance imaging study of cortical thickness in the same sample of adults with ADHD... Compared with healthy adults, adults with ADHD showed selective thinning of cerebral cortex in the networks that subserve attention and EF. In the present study, we found significant cortical thinning in ADHD in a distinct cortical network supporting attention especially in the right hemisphere involving the inferior parietal lobule, the dorsolateral prefrontal, and the anterior cingulate cortices. This is the first documentation that ADHD in adults is associated with thinner cortex in the cortical networks that modulate attention and EF.

 

Attention and Executive Systems Abnormalities in Adults with Childhood ADHD: A DT-MRI Study of Connections

Cerebral Cortex 2008 18(5):1210-1220; doi:10.1093/cercor/bhm156. In this study of adults with childhood ADHD, we hypothesized that fiber pathways subserving attention and executive functions (EFs) would be altered. To this end, the cingulum bundle (CB) and superior longitudinal fascicle II (SLF II) were investigated in vivo in 12 adults with childhood ADHD and 17 demographically comparable unaffected controls using DT-MRI. Relative to controls, the fractional anisotropy (FA) values were significantly smaller in both regions of interest in the right hemisphere, in contrast to a control region (the fornix), indicating an alteration of anatomical connections within the attention and EF cerebral systems in adults with childhood ADHD. The demonstration of FA abnormalities in the CB and SLF II in adults with childhood ADHD provides further support for persistent structural abnormalities into adulthood.

 

Volumetric MRI analysis comparing subjects having ADHD

with normal controls. Despite similar hemispheric volumes, ADHD subjects had smaller volumes of (1) left total caudate and caudate head (p <0.04), with reversed asymmetry (p < 0.03); (2) right anterior-superior (frontal) region en bloc (p < 0.03) arid white matter (p < 0.01); (3) bilateral anterior-inferior region en bloc (p <0.04); and (4) bilateral retrocallosal (parietal-occipital) region white matter (p < 0.03). Possible structural correlates of ADHD response to stimulants were noted in an exploratory analysis, with the smallest and symmetric caudate, and smallest left anterior-superior cortex volumes found in the responders, but reversed caudate asymmetry and the smallest retrocallosal white matter volumes noted in the nonresponders.

 

ADHD: More Prevalent Than We Thought?

LARISSA HIRSCH, MD Instructor of pediatrics at New York Presbyterian Hospital, medical editor for KidsHealth.org and CHARLES A. POHL, MD, professor of pediatrics and associate dean of student affairs and career counseling at Jefferson Medical College in Philadelphia

There are frequently stories in the news and talk among the public of the over-diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in today's hypervigilant society. However, a study recently published in Archives of Pediatrics and Adolescent Medicine may serve to debunk this common belief...Interestingly, only 47.9% of the caregivers of children who met the DSM-IV criteria in the past year reported that the disorder had been diagnosed in their child...Children from the lowest income group received less consistent treatment than those in higher income groups.

The Froehlich study indicates that we are under-diagnosing ADHD. We need to be on the lookout for children with this disorder, make an accurate diagnosis, and do our best to follow affected children closely.

 

Some Myths of ADHD

Myth # 1: ADHD is Not a Real Disorder
Myth # 2: ADHD is a Disorder of Childhood
Myth # 3: ADHD is Over-Diagnosed
Myth # 4: Children with ADHD are Over-medicated
Myth # 5: Poor Parenting Causes ADHD
Myth # 6: Minority Children are Over-Diagnosed with ADHD and are Over-Medicated
Myth # 7: Girls Have Lower Rates and Less Severe ADHD than Boys

 

ADHD Stigma and The ADHD Catch 22.

My article for Transitions Magazine the quarterly for The Disability Alliance of BC  ( used to be called BC Coalition of People with Disabilities (BCCPD) in their issue focusing on stigma.  Covers ADHD myths and how to deal with people who stigmatize ADDers.

 

Real Science Defines AD/HD as Real Disorder

From CHADD. Some of the most prestigious scientific-based organizations in the world conclude that AD/HD is a real disorder with potentially devastating consequences when not properly identified, diagnosed, and treated. Excerpts from the following organizations.

American Medical Association (AMA), Surgeon General of the United States, National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP)

Take the 5 minute Adult ADHD Screener test by Harvard, NYU and the WHO

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