ADD: How Dx is Made

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

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

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

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

• Inattention:

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

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

•  Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

• Impulsiveness:

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (example: butts into conversations or games).

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

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

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

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