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The Diagnosis Disorder

ADHD is a misunderstood condition. Leading experts in the field hold widely differing opinions on the cause, the treatment and even what ADHD is. How then are we average people diagnosed with ADHD, or parents with an ADHD child, expected to make decisions in this confusion?

With patience and common sense the average layperson can make informed decisions. ADHD (Attention Deficit Hyperactivity Disorder) is diagnosed and defined mainly with the criteria listed in the DSM-IV (Diagnostic and Statistic Manual of Mental Disorders 4th Revision). Understanding what is being diagnosed is the first step to dealing with ADHD.

The DSM-IV manual lists symptoms of ADHD and does NOT describe an illness. The use of the term "disorder" in this context is used for technical and legal reasons.

The DSM-IV explains some problems with the use of the term "disorder" in the introduction:

The problem raised by the term mental disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute. . . Mental disorders have also been defined by a variety of concepts (e.g., distress, dysfunction, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, a different situations call for different definitions.”

(Introduction page xxxi)

Further, regarding a medical diagnosis for ADHD, the DSM-IV states:

There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder..”

(DSM-IV page 88)

An inaccurate understanding and use of the DSM-IV ADHD diagnosis is the main cause for the confusion on the subject of ADHD. This manual is a guide, which is continually being revised and therefore cannot be used as a manual of scientific fact. At present the fifth revision is being prepared. It is a diagnostic and statistical guide of symptoms, not descriptions of illnesses. There is a huge difference.

What is described in the DSM-IV for ADHD are behavior patterns, which are the symptoms of ADHD and not a description of a disease or sickness. Unfortunately it is not only laypeople that have misunderstood the term, but even scientists conducting research on the subject.

Symptoms are not an illness, but a guide to treatment. Malaria shares many symptoms with other illnesses. Those sicknesses are not malaria even if they have some common symptoms. The illness malaria is caused by parasites in the bloodstream. A characteristic symptom that defines malaria as the possible sickness is a high temperature together with a chill and shivering. Feeling a chill is not the illness, but the symptom the patient feels as more parasites infest more blood cells, which is the illness.

Similarly the behavior associated with ADHD is not a disorder or illness. What causes that behavior is the problem. Those behaviors are shared with a number of other conditions, Bipolar Disorder being one. The different conditions have different causes and therefore how ADHD is treated must depend on what is causing it.

When a diagnosis is used to find the cause of a condition and the cause is made the primary focus to the treatment then the therapy is often successful. However when the diagnosis is primarily fixated with symptoms, then the therapy is directed at masking those symptoms, making the treatment of the cause more difficult and therefore the therapy is counterproductive in the long term.

There are five basic causes of ADHD like symptoms:

  1. Physiological causes such as allergies, poisoning, or lack of certain nutrients that particular individual needs.
  2. Medical causes such as hyperthyroidism
  3. Emotional causes such as parental neglect, rejection, bullying or abuse.
  4. Other conditions such as autism, oppositional defiant disorder or conduct disorder.
  5. An ADHD personality.

The first four categories are not ADHD and should not be treated as such.

In time the causes of the spectrum of ADHD like behavior patterns will be understood more fully. While much effort has been made in the last decade to research ADHD, most has unfortunately centred on one cause, one disorder and one cure. There is no universal cause for ADHD behavior and there is no one universal answer either.

ADHD like behavior is a multi faceted problem, but using commonsense together with looking at the various opinions with an open mind we can find the solutions and treatments that suit each one of us.

In this regard, it is important to have the guidance of an experienced health professional, who is aware of the various causes and treatments for this complex condition. ADHD meds do have a place in ADHD treatments, mainly as a temporary crutch, while the lasting solutions lie in alternative treatments, from Cognitive Behaviour Therapy, through ADHD coaching, to diet and supplements.

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